Major trauma mandates prompt ophthalmologic evaluation

Children who undergo an ocular injury that ranks higher than a 15 on the Injury Severity Score are more likely to experience orbital wall fractures and ocular contusions than children with a score lower than 15, according to a large study.

Tracey A. Garcia, MD, and colleagues analyzed data from 7,497 children with ocular and adnexal injuries in the National Pediatric Trauma Registry. All cases were stratified for Injury Severity Score (ISS), in which a ranking of more than 15 indicates major trauma.

Almost 8% of the more than 96,000 children in the registry sustained an ocular injury. Of those with an ocular injury, three-fourths had an ISS under 15. For the 25% of registrants with an ISS score of more than 15, the percent of orbital wall fractures, injuries to the optic nerve and injuries to the other ocular cranial nerves doubled and the percent of basilar skull fractures tripled in comparison with those with an ISS score under 15. There were fewer globe injuries in children with a higher ISS, and penetrating globe injuries were significantly lower in children with a higher ISS as well.

More than 70% of the eye injuries with an ISS of greater than 15 were sustained in an accident involving a vehicle, and 75% of those who could have been restrained were not, the study authors said.

The study is published in the July issue of The Journal of Trauma.