A comparison of pediatric ocular injuries based on intention in patients admitted with trauma.

PURPOSE: Pediatric ocular trauma is a major source of morbidity and blindness and the number of epidemiological studies is incommensurate with its significance. We sought to determine differences in epidemiologic patterns of pediatric ocular injuries based on intention. METHODS: A retrospective review of the National Trauma Data Bank (2008-2014) was performed and patients < 21 years old, admitted with trauma and ocular injury, were identified using ICD-9CM codes. Demographic data, types of injury and external circumstances including intention were tabulated and analyzed with students' t and chi-squared tests and logistic regression. Statistical significance was set at p < 0.05. RESULTS: Fifty-eight thousand seven hundred sixty-five pediatric patients were admitted for trauma and ocular injuries. The mean(SD) age was 11.9(6.9) years. Most patients were male (68.7%) and White (59.1%). Unintentional injuries (76.3%) were mostly associated with falls (OR = 13.4, p < 0.001), assault (16.3%) with firearms (OR = 9.15, p < 0.001) and self-inflicted trauma (0.7%) also with firearms (OR = 44.66, p < 0.001). There was increasing mean(SD) age from unintentional, 12.9(6.6) years and assault 12.3(8.1) years to self-inflicted trauma, 17(3.4) years. The 0-3 year age group had highest odds of open adnexa wounds (OR = 30.45, p < 0.001) from unintentional trauma, and traumatic brain injury (TBI) (OR = 5.77, p < 0.001) and mortality (OR = 8.52, p < 0.001) from assault. The oldest 19-21 year group, had highest odds visual pathway injuries (OR = 8.34, p < 0.001) and TBI (OR = 1.54, p = 0.048) from self-inflicted trauma and mortality (OR = 2.08, p < 0.001) from unintentional trauma. CONCLUSION: Sight-threatening injuries were mostly associated with unintentional trauma in the youngest group and self-inflicted trauma in the oldest group. Patterns emerged of associations between demographic groups, mechanisms, types of injury and associated TBI with intention of trauma.

Shaken baby syndrome.

PURPOSE: To examine the comprehensive ophthalmologic experience with the shaken baby syndrome at one medical center, including clinical findings, autopsy findings, and the outcome of survivors. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One hundred twenty-three children admitted from January 1987 through December 1998 for subdural hematomas of the brain secondary to abuse were included. METHODS: Clinical features of eye examinations of the patients during their admission and after discharge and histopathologic observations for patients who died were retrieved from medical records and statistically analyzed. MAIN OUTCOME MEASURES: Visual response and pupillary response on initial examination, fundus findings, final vision, neurologic outcome of survivors, and death. RESULTS: Ninety percent of the patients had ophthalmologic assessments. Retinal hemorrhages were detected in 83% of the examined children. The retinal hemorrhages were bilateral in 85% of affected children and varied in type and location. Nonophthalmologists missed the hemorrhages in 29% of affected patients. Poor visual response, poor pupillary response, and retinal hemorrhage correlated strongly with the demise of the child. One child who died had pigmented retinal scars from previous abuse, a condition not previously observed histopathologically to our knowledge. One fifth of the survivors had poor vision, largely the result of cerebral visual impairment. Severe neurologic impairment correlated highly with loss of vision. CONCLUSIONS: Shaken baby syndrome causes devastating injury to the brain and thus to vision. Retinal hemorrhages are extremely common, but vision loss is most often the result of brain injury. The patient's visual reaction and pupillary response on presentation showed a high correlation with survival. Good initial visual reaction was highly correlated with good final vision and neurologic outcome. According to the literature, when retinal hemorrhages are found in young children, the likelihood that abuse occurred is very high. Nonophthalmologists' difficulty in detecting retinal hemorrhages may be an important limiting factor in identifying shaken babies so they can be protected from further abuse.

The primary treatment of traumatic lesions of the orbital roof.

The possible treatments for dislocated fractures of the orbital roof range from reduction of the fracture fragments, and reconstruction and stabilisation with miniplates, to plastic surgery using autologous bone. Between 1988 and 1994, 105 patients treated in the Department of Neurosurgery of the Landesnervenklinik Salzburg were operated on transcranially for fractures of the orbital roof. The methods of treatment, the timing of treatment, and the results are discussed. It is shown that even in severely injured patients the results were good in 83 patients (79%).

Accidents in the workplace.

A prospective survey of patients attending the central Accident and Emergency Department and Eye Casualty Department in Aberdeen was made to determine the contribution of accidents at work to the workload of the departments and to estimate risks of injury in different industrial sectors. Work-related injuries accounted for 16.5 per cent of new patients attending the general accident department and 21.7 per cent of those attending eye casualty. Analysis by industrial sector led to estimates that almost one in 10 workers employed in manufacturing industries and in agriculture/forestry/fishing will attend casualty in the course of a year for a work-related injury. The relatively low-risk service sector, because of the large numbers of people employed, contributed the greatest number of individuals with work-related injuries. Two industries had very high rates of specific and preventable injuries--food and fish processing with an estimated 17 knife lacerations per 1000 per annum and mechanical engineering with 60 eye injuries per 1000 per annum. We give reasons for believing that our estimates of risk in the different industrial sectors are conservative.