Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the Intelligent Research in Sight (IRIS®) Registry.

Purpose: To identify clinical factors associated with the need for future surgical intervention following closed globe ocular trauma. Design: Retrospective cohort study. Subjects Participants and/or Controls: Patients in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry with a diagnosis of closed globe ocular trauma occurring between 2013 and 2019, identified using International Classification of Disease, 10th Revision and Systematized Nomenclature of Medicine codes. Methods: Diagnosis codes were used to identify multiple concomitant diagnoses present on the date of closed globe ocular trauma. Survival analyses were performed for each outcome of interest, and linear regression was used to identify clinical factors associated with the risk of surgical intervention. Main Outcome Measures: Outcomes included retinal break treatment, retinal detachment (RD) repair, retinal break treatment or RD repair, glaucoma surgery, and cataract surgery. Results: Of the 206 807 patients with closed globe ocular trauma, 9648 underwent surgical intervention during the follow-up period (mean, 444 days): 1697 (0.8%) had RD repair, 1658 (0.8%) had retinal break treatment, 600 (0.3%) had glaucoma surgery, and 5693 (2.8%) had cataract surgery. Traumatic cataract was the strongest risk factor for cataract surgery (hazard ratio, 13.0; 95% confidence interval, 10.8-15.6), traumatic hyphema showed highest risk for glaucoma surgery (7.24; 4.60-11.4), and vitreous hemorrhage was the strongest risk factor for retinal break treatment and detachment repair (11.01; 9.18-13.2 and 14.2; 11.5-17.6, respectively) during the first 60 days after trauma date. Vitreous hemorrhage was a risk factor for cataract surgery at > 60 days after trauma date only. Iris-angle injury was the strongest risk factor for glaucoma surgery > 60 days after trauma, while vitreous hemorrhage remained the strongest factor for retinal break treatment and detachment repair at > 60 days. Traumatic hyphema was a risk factor for all surgical outcomes during all follow-up intervals. Conclusions: Diagnosis of concomitant traumatic cataract, vitreous hemorrhage, traumatic hyphema, and other risk factors may increase the likelihood of requiring surgical intervention after closed globe ocular trauma.

Clinical Audit on Badminton-Related Ocular Injuries in a Tertiary Hospital in Malaysia.

Background Badminton-related ocular injuries are among the commonest causes of blunt trauma to the eye, which can lead to significant damage to the ocular structures. This study aimed to assess the clinical presentations, complications, and visual outcomes of patients who sustained ocular injuries related to badminton treated in a single tertiary center in Malaysia. Materials and methods A retrospective clinical audit was conducted in Hospital Universiti Sains Malaysia (HUSM), Malaysia, involving patients diagnosed with ocular injuries related to badminton, either as players or spectators, between January 1, 2003 and December 31, 2017. The demographic data, mechanism of injury, and clinical presentation were recorded. In addition, visual acuity, anterior and posterior segment, and intraocular pressure (IOP) measurements were recorded at the initial presentation and at the present recruitment period. Management at the initial presentation was also obtained and recorded. The final visual outcome and complications were based on the finding of the most recent follow-up. Visual acuity was categorized as follows: mild or no visual impairment (6/18 or better), moderate and severe visual impairment (<6/18 and worse). Results A total of 23 patients (23 eyes) were included in this clinical audit. The average age was 24 years, with a range of 6-56 years, with the highest incidence occurring at the age of 20 years old and younger. The majority of the injuries were sustained during the single-player game. All the injuries were caused by shuttlecock hits. In 18 cases (78%), the trauma was caused by an opponent, in four cases (17%) by a partner, and in one case involving a bystander. Most of the patients in this series were not using any protective eyewear while playing the game 96% (22). Most injuries (22 eyes) involved the anterior segment, with hyphaema as the commonest clinical presentation. The mean IOP at presentation was 23.5 (11.2) mmHg. Angle recession was detected as early as one-week post initial presentation in 17 eyes. Commotio retinae (5 eyes) and vitreous hemorrhage (4 eyes) were the common posterior segment findings. There were eight eyes with visual acuity of worse than 6/18 at the initial presentation, but only three eyes had poor final visual acuity. There was a statistically significant improvement in visual acuity at the last follow-up compared to the initial presentation (Fisher's exact test) (p=0.032). Conclusion Ocular injuries related to badminton is common and cause a detrimental effect on the long-term visual outcome. Traumatic hyphaema and commotio retinae are the most common presenting signs related to poor visual outcomes. Therefore, protective eyewear and promoting awareness of badminton-related ocular injuries are essential to prevent monocular blindness in young adults.

Bilateral Hyphema - An Unexpected Complication of Exercise Resistance Band Use: A Case Report.

BACKGROUND: Resistance bands commonly used for strength training exercise come with an unexpected risk for ocular trauma. CASE REPORT: In this report, we describe an unintended consequence of a 28-year-old man sustaining an unusual injury-bilateral hyphema-as a result of the use of elastic resistance bands. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Resistance bands are commonly used for strength training exercise and, in this case, a potentially severe, vision-threatening injury-traumatic hyphema-occurred. Traumatic hyphema occurs when blood pools in the anterior chamber of the eye, usually as the result of blunt force trauma or penetrating injury. Early recognition of this condition is imperative, as complications of traumatic hyphema, such as intraocular hypertension or rebleeding, can lead to permanent vision loss.

Systemic prednisolone versus topical tranexamic acid for prevention of rebleeding in patients with traumatic hyphema: A randomized clinical trial.

PURPOSE: To compare the efficacy of systemic prednisolone and topical tranexamic acid (TA) on the rate of rebleeding in patients with macroscopic traumatic hyphema (MTH). METHOD: In a randomized clinical trial, patients with MTH were randomized to receive oral prednisolone (OP group) or topical TA drops (TA group). Comprehensive ophthalmic examinations including slit lamp examination and fundoscopy, intraocular pressure (IOP), best-corrected visual acuity (BCVA) and check for rebleeding were performed in all cases. RESULTS: Ninety eyes of 90 patients were included, and 45 patients were allocated into each group. Age, sex, IOP, BCVA and grade of hyphema were not different between groups. Rebleeding in the TA group (2 patients, 4.4%) occurred less frequently than in the OP group (7 patients, 15.6%), but this difference did not reach statistical significance (P=0.081). However, there was a significant difference between the two groups over time in terms of absorption of the MTH (P<0.001). CONCLUSION: Topical TA appears promising in the management of macroscopic traumatic hyphema.

Epidemiology and outcomes of hyphema: a single tertiary centre experience of 180 cases.

PURPOSE: To characterize the epidemiology and outcomes of hyphema. METHODS: Retrospective case series. Medical records from patients with traumatic and spontaneous hyphema seen at the Wilmer Eye Institute, Johns Hopkins, from 2011 through 2017 were evaluated. Aetiology, demographics, clinical characteristics, complications, management and outcomes were ascertained. Multivariable logistic regression was used to identify factors associated with elevated intraocular pressure (IOP), rebleeding and poor outcome (final visual acuity ≤ 20/40) in traumatic hyphema. A safe frequency of follow-up was retrospectively determined. RESULTS: Traumatic hyphema (n = 152) was more common in males (78%) and adults (55%), with sports/recreational activities being the most frequent cause (40%). Elevated IOP was the most common complication (39%). Rebleeding occurred in seven patients (5%) and was more likely with a higher IOP on presentation (OR:1.1; p = 0.004). Thirty-seven patients (24%) had a poor outcome, mostly due to traumatic sequelae such as cataract (32%) or posterior segment involvement (30%). A poor outcome was more likely with worse presenting visual acuity (OR: 9.1; p = 0.001), rebleeding (OR: 37.5; p = 0.035) and age > 60 years (OR: 16.0; p = 0.041). Spontaneous hyphema (n = 28) did not have a gender predominance and was more common in adults > 60 years (71%). The most common cause was iris neovascularization (61%). Complications and visual outcomes were worse compared with traumatic hyphema. CONCLUSIONS: Traumatic hyphema continues to be common in young males engaging in sports, necessitating increased awareness for preventive eyewear. Older age and rebleeding can lead to poor outcomes. Elevated IOP at presentation predisposes to rebleeding and warrants frequent follow-up. Otherwise, routine follow-up at days 1, 3, 5, 7 and 14 is sufficient for uncomplicated cases.

Gradual spontaneous resolution of corneal bloodstaining after anterior chamber irrigation for rebleeding secondary to traumatic hyphema.

Corneal bloodstaining, which is brown or dark yellow in color, is induced by hemoglobin deposition, and its breakdown products extend into the corneal stroma. In this article, we report a rare case of corneal bloodstaining induced by total hyphema after rebleeding for traumatic hyphema. The patient underwent irrigation of the anterior chamber (AC) and cataract surgery of the right eye after trauma. After oral and topical treatment the imprint of corneal bloodstaining faded, and it nearly disappeared after the procedures. Corneal bloodstaining is undoubtedly a vision-threatening complication of total hyphema after ocular trauma, surgical intervention, and even rebleeding. Removal of the total hyphema as soon as possible decreases the severity of corneal bloodstaining, shortens the course of spontaneous healing, and thus improves vision.

The Incidence and Risk Factors for Ocular Hypertension in Traumatic Hyphema

PURPOSE: To evaluate the incidence and risk factors for ocular hypertension (OHT) in traumatic hyphema within 7 days after trauma. METHODS: A retrospective case series study of 265 traumatic hyphema inpatients from 2010–2016. OHT was defined as intraocular pressure (IOP) that exceeded 21 mmHg using two consecutive measurements by a Goldmann applanation tonometer within 7 days after trauma. The subjects were divided into two groups (OHT group and non-OHT group). Age, sex, best-corrected visual acuity (BCVA), IOP, hyphema grade, presence of systemic disease, and past history of glaucoma were compared between the two groups. RESULTS: Of the 265 patients, 95 (35.8%) developed OHT after traumatic hyphema. Of those 95 patients, 70 (73.7%) developed OHT within 1 day after trauma; 18 (18.9%) developed OHT 2–3 days after trauma; and 7 (7.4%) developed OHT 4–7 days after trauma. Compared to the non-OHT group, the OHT group had a lower visual acuity (p = 0.018) and higher IOP (p < 0.001). In addition. if the hyphema grade was higher the incidence of OHT was significantly higher (p = 0.017). Using multivariate logistic regression analysis, the BCVA (p = 0.045) and hyphema grade (p = 0.006) were associated with the incidence of OHT in traumatic hyphema within 7 days after trauma. CONCLUSIONS: The incidence of OHT in traumatic hyphema within 7 days after trauma was 35.8%. The BCVA and hyphema grade were associated with the incidence of OHT within 7 days after trauma.

Trabeculectomy for traumatic hyphema in sickle cell trait.

A case report of a traumatic hyphema in a patient with sickle cell trait is presented. A review of the published literature in PubMed was performed and medical management strategies and surgical treatment indications for traumatic hyphema are discussed. We support the case for temporary trabeculectomy in patients with traumatic hyphema and sickle cell disease.

Effect of Hexue mingmu tablets in the treatment of hyphema / 国际眼科杂志(Guoji Yanke Zazhi)

To evaluate the effect of Hexue mingmu tablets on traumatic hyphema caused by blunt ocular trauma. ●METHODS: Totally 150 patients of traumatic hyphema were divided into seven types by using ultrasound biomicroscopy combining with anterior segment abnormalities, each type was randomly classified as trial group and control group. The trial group was administered Hexue mingmu tablets, control group was treated by hemocoagulase. ●RESULTS: The absorbing time of trial group was shorter than that of the control group. And there was statistical significance between the two groups (P ● CONCLUSlON: Hexue mingmu tablets is an effective medicine to treat traumatic hyphema. Ultrasound biomicroscopy can be used as a routine examination method in traumatic hyphema.

Caracterización de los traumatismos oculares severos en la infancia / Characterization of severe ocular traumas in childhood

Objetivo: caracterizar clínica y epidemiológicamente el trauma ocular severo en edad pediátrica. Métodos: se realizó un estudio descriptivo, retrospectivo de serie de casos, en pacientes pediátricos que ingresaron por trauma ocular severo, atendidos en el Servicio de Urgencias y Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer de enero a diciembre del 2010. La muestra fue de 63 pacientes menores de 19 años de edad, de ambos sexos. Se analizaron diferentes variables demográficas (edad, sexo), y epidemiológicas: evento traumático, agudeza visual grados según puntaje del trauma ocular OTS, tipo de lesión (globo abierto o cerrado) y zona afectada. Resultados: el 81 por ciento fueron varones, y predominó el grupo de edad entre 5 y 9 años (38,1 por ciento ). Hubo un predominio de los traumas cerrados sobre los de globo abierto. Los traumas cerrados se localizaron fundamentalmente en la Zona II, y los abiertos en la Zona I para un 94,3 y 67,8 por ciento respectivamente. Conclusiones: el trauma ocular a globo cerrado particularmente las contusiones localizadas en la Zona II fueron los que más se presentaron. Con relación al pronóstico visual según los valores del OTS hubo gran similitud entre las diferentes categorías y el resultado visual final

Objective: to characterize clinically and epidemiologically the severe ocular trauma at pediatric ages. Methods: a retrospective and descriptive case series study was conducted in pediatric patients, who were admitted to emergency pediatric ophthalmology service of Ramon Pando Ferrer Cuban Institute of Ophthalmology due to severe ocular trauma from January to December 2010. The sample was made up of 63 patients less than 19 years of age of both sexes. The following demographic (age and sex) and epidemiological variables such as trauma event, visual acuity according to the ocular trauma score, type of lesion (open or close eyeball) and affected area were analyzed. Results: in this group, 81 percent were males and the predominant age group was 5 to 9 years (38.1 percent). Close eyeball trauma prevailed over open trauma, the former were mainly located in Zone II, whereas the latter were found in Zone I, accounting for 94.3 percent and 67.8 percent, respectively. Conclusions: ocular trauma of close eyeball-type, mainly contusions placed in Zone II, was the most frequent. As to the visual prognosis according to the ocular trauma scoring, there was great similarity between the different categories and the final visual outcome

Clinical Significance of Ultrasound Biomicroscopy in Early Stage of Traumatic Hyphema

PURPOSE: To evaluate the clinical significance of angle-opening distance 500 (AOD500) using ultrasound biomicroscopy (UBM) in the early stage of traumatic hyphema. METHODS: The participants of this study were 46 hospitalized traumatic hyphema patients. We measured the quantity of initial blood clotting using a slit-lamp and the range of angle recession, AOD500 using UBM and then reviewed the relationship between the two. RESULTS: The difference of AOD500 in the traumatic and the non-traumatic eye measured by UBM at admission increased significantly in the wider recessed angle group (p=0.008), but did not increase at a statistically significantly level in the larger initial blood clot grade group (> or =Grade 2). CONCLUSIONS: These results suggest that the measurement of the angle-opening distance of both eyes using UBM will aid in evaluating the range of angle recession in patients in the early stage of traumatic hyphema.

Contemporary aspects in the prognosis of traumatic hyphemas.

PURPOSE: The present study concerns traumatic hyphemas and their prognostic factors and signs. The aim of this study is to determine the prognostic factors and signs of traumatic hyphemas. METHODS: During the last five years, 72 young individuals were hospitalized with the diagnosis of suffering a traumatic hyphema and were divided in three groups according to the extent of their hyphema. The first group concerns 38 patients with a small hyphema 3-4 mm, the second group concerns 22 patients with moderate hyphema reaching the pupillary border, and the third group concerns 12 patients with a total hyphema. RESULTS: The hyphema was absorbed in 63 patients and the IOP was controlled with medical treatment after 3-24 days. However, surgical management was necessary for two patients. Finally, antiglaucomatous treatment was administered in seven patients with persistent high intraocular pressure. CONCLUSIONS: The important clinical signs that determine the prognosis of such hyphemas are the size of hyphema, the blood color, recurrent hemorrhage, the absorption time, the increase of intraocular pressure, and blood staining of the cornea.

Corneal Endothelial Changes in Patients with Traumatic Hyphema

PURPOSE: In patients with traumatic hyphema, we investigated the changes of corneal endothelium and the associated ocular complications that might attribute to endothelial damage. MATERIALS & METHODS: We reviewed the medical records of 67 patients(67 eyes) who had been admitted and treated for blunt ocular trauma with hyphema between February 1997 and June 2000. One month after injury, endothelial photographs of both eyes of each patient were taken with specular microscope to compare the endothelium of the injured eyes with that of the normal fellow eyes. The endothelial parameters were studied in relationship to various complications to see the relationship between the complications and the endothelial damage. RESULTS: Compared with the fellow uninjured eyes, the injured eyes had a mean decrease in endothelial cell density (ECD) of 5.6% (P=0.015). Nine patients had significant corneal edema with epithelial defect on initial admission, which was defined as corneal impact lesion. In the group with the corneal impact lesion, the mean ECD decrease was 23.1% (P=0.016) and the mean coefficient of variation (COV) increase was 24.8% (P=0.01). With other variables such as the amount of hyphema and the degree of angle recession, statistically significant results could not be obtained. In 20 patients on long-term follow-up examination (mean 36.7 months after the injury), the injured eyes had a mean increase in ECD of 2.5% compared to the result on initial examination. This change was minimal and statistically not significant. CONCLUSION: In patients with traumatic hyphema, this study showed reduced endothelial cell densities in the injured eyes compared to the normal fellow eyes. In particular, statistically significant decrease in ECD was noted to be associated with corneal impact lesion.

The Incidence of Complication and Decreased Visual Acuity in Traumatic Hyphema Patients According to the Amount of Blood Clot

We reviewed the medical records of 122 patients (122 eyes) who had been admitted for the traumatic hyphema at the Wallace memorial Baptist Hospital between January 1993 and June 1996, excluding perforating eye injury. And according to the degree of hyphema, the incidence of its complications such as early glaucoma, late glaucoma, rebleeding, or conreal staining , and decreased final visual acuity was analyzed. The degree of hyphema was graded by the amount of the anterior chamber filled with blood clot after layering of the red blood cells: Grade I was defined as less than one third of anterior chamber, Grade II as one third to one half of it, Grade III as one half to nearly total of it, or Grade IV as total of it. The early or late glaucoma was defined as intraocular pressure using Goldmann` s applanation tonometer of 21mmHg or more on admission or at about 1 month after admission. The decreased final visual acuity is defined as final corrected visual acuity using Hans chart of 0.5 or less. Of 122 eyes, there were 92 eyes(75.4%) in Grade I, 20 eyes(16.4%) in Grade II, 6 eyes(4.9%) in Grade III, or 4 eyes(12.3%) in Grade IV. According to the grade, the incidence of early glaucoma was 10.9%(10 eyes) in Grade I, 25.0%(5 eyes) in Grade II, 16.7%(1 eye) in Grade III, or 25.0%(1eye) in Grade IV; that of late glaucoma was 3.3%(3eyes) in Grade I, 5.0%(1 eye) in Grade II, zero in Grade III, or 25%(1 eye) in Grade IV; that of rebleeding was zero in Grade I, 10.0%(2 eyes) in Grade II, 50.0%(3 eyes) in Grade III, or 50.0%(2 eyes) in Grade IV; that of conreal staining was 50.0%(2 eyes) in Grade IV but zero in Grade I, Grade II or Grade III; and that of decreased final visual acuity was 8.7%(8 eyes) in Grade I, 20.0%(4 eyes) in Grade II, 33.3%(2 eyes) in Grade III or 25%(1 eye) in Grade IV. The higher the grade, the higher the incidence of its complication and decreased final visual acuity not showing the statistical significance (P>0.05). However, the incidence of rebleeding and decreased final visual acuity was higher in Grade II to IV groups showing the statistical significance in comparison with Grade I(P<0.01). Therefore, it is considered that diagnosis, treatment , and follow-up should be made correctly and attentively in Grade II to IV groups than in Grade I.

A Clinical Study on Trauamtic Hyphema in Chunbuk area

A retrospective study was made of 334 consecutive cases of traumatic hyphema in the rural Chonbuk population. The average age of these patients was 26.2 years with the majority being male(91.9%). The major causes of traumatic hyphema were blow injuries(166 patients, 49.7%). The only 13 aptients(3.9%) had agriculture related injuries. Secondary hemorrhage occured in 23(6.9%) of all patient, and mainly between the second and fourth day following admission. A separate group of 88 patients(26.3%) who were admitted to hospital 24 hours or more after sustaining injury were found to have a secondary hemorrhage rate of 10.2%(nine of 88 patients). No secondary hemorrhage occured in Grade 0 hyphema. 22 eyes(6.5%) had a final visual acuity of 0.3 or worse. Retinal pathology,not hemorrhage, was most often responsible among those patients suffering poor visual outcome. In this study on the population of Chunbuk province, some patients were treated late, and had a high incidence of secondary hemorrhge.

Comparative Studies of Management on Traumatic Hyphema

In order to see whether the binocular patching with cycloplegia improves the prognosis in the treatmet of traumatic hyphema, we studied prospectively 77 patients with nonperforating traumatic hyphema who were admitted and treated at the Chonnam University Hospital between January 1994 and July 1995. We analyzed the clearance time of blood clot in the anterior chamber, the incidence of rebleeding and the final visual acuity. The patients were divided into four groups : group I, of 17 patients treated by monocular patching ; group II, of 19 patients treated by monocular patching with cycloplegia ; group III, of 20 patients treated by absolute bed rest with binocular patching ; group IV, of 21 patients treated by absolute bed rest with binocular patching and cycloplegia. The average clearance time of blood clot was 7.4 days in group I, 7.4 days in group II, 6.9 days in group III and 7.5 days in group IV. The incidence of rebleeding was 5.8% (n=1) in group I, 10.5% (n=2) in group II, 0% (n=0) in group III, 14.3% (n=3) in group IV. The final visual acuity of 0.6 or better was achieved in 10 patients (58.8%) of group I, 13 patients (68.4%) of group II, 13 patients (65.0%) of group III, 14 patients (66.7%) of group IV. In the treatment of traumatic hyphema, binocular and monocular groups as well as cycloplegic and non-cycloplegic groups showed no significant difference from each other in the clearance time of blood clot, incidence of rebleeding and the final visual acuity.

Clinical Analysis of Ocular Injuries induced by Power Lawn Mowers

The authors analysed 22 patients who were admitted to Gyeongsang National University Hospital because of ocular injuries induced by Power lawn mowers from March 1, 1991 to December 31, 1994. All of the patients were males. The average age of the patients was 43.3(range 15-69). Most injuries occured between June and September. Perforating injuries were developed in 8(36.4%) of 22 eyes and non-perforating injuries in 14(63.6%) eyes. The type of injuries were lens damage(10/22), vitreous hemorrhage(8/22), iridodialysis(4/22), intraocular foreign body(3/22), endophthalmitis(2/22), retinal detachment(1/22), and choroidal rupture(1/22). The prognosis was poor when the eyeball was perforated. Therefore safety goggles are absolutely needed for prevention of ocular injuries induced by Power lawn mowers.

The Effect of Aminocaproic Acid and Prednisolone in the Traumatic Hyphema

It is recognized that rebleeding of traumatic hyphema may predispose patients to several complications including decreased visual acuity. We reviewed the medical records of 92 patients(92 eyes) with the diagnosis of nonperforating traumatic hyphema. The relative efficiencies of Aminocaproic acid and systemic Predisolone for reducing rate of rebleeding and their side effects were evaluated under the statistical analysis. Fourty-seven patients received an oral dosage of 50 mg/kg of Aminocaproic acid every 4 hours for 5 days(up to a maximum 30 gm/day), and fourty-five patients took an oral dosage of 0.6 mg/kg of Prednisolone daily in two devided doses. The frequency of rebleeding was not statistically significantly different between the aminocaproic acid treated group(4.3%, 2/47 patients) and the prednisolone treated group(6.7%, 3/45 patients). The developing rates of their acute adverse reaction were statistically different between the aminocaproic acid treated group(44.7%, 21/47 patients) and the prednisolone treated group(20%, 9/45 patients).

Clinical Study of Risk Factors Associated with the Development of Rebleeding After Traumatic Hyphema

We reviewed the medical records of 201 patients who were admitted between January 1980 and March 1992 with a diagnosis of traumatic hyphema to define risk factors associated with the development of rebleeding. Rebleeding occurred in 18 patients (9.0%), and took place on day 1 to 6 after injury with a maximum occurrence on day 2. A group of 32 patients who were examined more than 24 hours after injury were found to have a rebleeding rate of 18.8% (six of 32 patients). It was higher than the rebleeding rate (6.8%) in patients examined within 24 hours. When the amount of blood is more than 1/3 of anterior chamber at the time of initial examination, rebleeding was shown to occur more frequently. Children had a rebleeding rate similar to adults, and males showed approximately the same rate of rebleeding compared to females. This review suggests that patients examined more than 24 hours after injury and injured severely represent unique population that deserves special consideration.