• Ocular and Brain Injury in Pediatric Trauma Patients

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    Journal of AAPOS
    2018;22(6):421-425

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    In a large retrospective study, Gise et al. evaluated the relationship between traumatic brain injury (TBI) and sight-threatening ocular injury. They found that nearly 55% of pediatric trauma patients with ocular comorbid­ity were found to have TBI. The most common ocular injuries in patients with TBI were orbital fractures and contusions of the eye or adnexa.

    For their research, the authors used the U.S. National Trauma Data Bank registry to review records of pediatric patients who were hospitalized for trauma from 2008 through 2014. Ocular injuries were categorized by type and location. TBI was identified by relevant ICD-9 codes (for skull frac­ture; intracranial injury; shaken baby syndrome; injury to the optic chiasm, optic pathway, or visual cortex; and head injury not otherwise specified).

    Of the 58,765 pediatric patients (< 21 years of age) with concomitant trauma and ocular injury upon admis­sion, 32,173 (54.8%) were diagnosed as having TBI. The majority were 12-18 years of age (41.3%), and 69.8% were boys. The most common ocular injuries associated with TBI were contusions of the eye/adnexa (39.1%) and orbital fractures (35.8%). Globe ruptures were not significantly associat­ed with TBI and occurred in only 5.1% of cases.

    With regard to age distribution, younger children were more likely to be injured at home, particularly during a fall, while adolescents were more likely to be injured as a result of a motor vehicle accident. With regard to racial distribution, blacks and Hispanics were most likely to be injured during an assault, while whites were more likely to have self-inflicted or unintentional wounds. Whites also were more likely to be injured in a motor vehicle accident. Firearm-inflicted trauma was highest among blacks, and Hispanics had the greatest risk of being injured because of being struck by a motor vehicle.

    These findings demonstrate that TBI is common among trauma patients with concurrent ocular injury. Demo­graphic patterns may help to identify patients with the greatest risk of TBI, leading to earlier diagnosis and treat­ment.

    The original article can be found here.