Neta Cohen1,2, Eyal Cohen3,4, Adi Anafy3,5, Anat Margaliot3,5, Kira Kaganov3, Nir Gomel3,4, Dana Barequet3,4, Daphna Mezad-Koursh3,4, Ayelet Rimon6,3. 1. Pediatric Emergency Medicine Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. netarab81@gmail.com. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. netarab81@gmail.com. 3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 5. Department of Pediatrics, Dana Duek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 6. Pediatric Emergency Medicine Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Abstract
Eye injuries are important cause of ocular morbidity in children. There is lack of data regarding predictors for high-risk injuries that will result in ophthalmic complications. Most cases are managed by the emergency department (ED) physicians without immediate ophthalmologist evaluation. Our aim was to identify predictors for ophthalmological complications and to imply indications for early ophthalmologic consultation in the ED. A retrospective chart review of 834 patients ages 0-18 years who presented to the emergency department at Tel Aviv Medical Center between 2015 and 2018 following traumatic eye injuries was performed. All cases which later needed ophthalmological care were considered as high-risk for ophthalmic complications. An increased rate of eye injury was revealed over the years, but high-risk injury rate was stable. High-velocity mechanism, sport injury, orbital, anterior chamber, and retinal involvement were all significantly more common in the high-risk group compared to the low risk group. Only 10 patients, which represent 1.2% of all the patients, had decreased visual acuity on the last follow up, with significantly more injuries of high-velocity mechanism and anterior chamber involvement, in comparison to patients with normal visual acuity on the last follow up. Conclusion: High-velocity mechanism by itself, even with normal visual acuity and eye examination by the ED physician, should prompt to consider an urgent ophthalmologist consult. What is Known: •Traumatic eye injuries are an important cause of ocular morbidity in children. • Most injuries can be handled by a trained ED physician, but there are indications for an urgent ophthalmologist consultation. • It is crucial to discriminate between low and high-risk ocular injuries. What is New: • High-velocity mechanisms stand out as the most likely risk factor for final impaired visual acuity. • Normal visual acuity on presentation is not reassuring. • We recommend urgent ophthalmologist consultation in cases of high-velocity injury, even if visual acuity is preserved at presentation.
Eye injuries are important cause of ocular morbidity in children. There is lack of data regarding predictors for high-risk injuries that will result in ophthalmic complications. Most cases are managed by the emergency department (ED) physicians without immediate ophthalmologist evaluation. Our aim was to identify predictors for ophthalmological complications and to imply indications for early ophthalmologic consultation in the ED. A retrospective chart review of 834 patients ages 0-18 years who presented to the emergency department at Tel Aviv Medical Center between 2015 and 2018 following traumatic eye injuries was performed. All cases which later needed ophthalmological care were considered as high-risk for ophthalmic complications. An increased rate of eye injury was revealed over the years, but high-risk injury rate was stable. High-velocity mechanism, sport injury, orbital, anterior chamber, and retinal involvement were all significantly more common in the high-risk group compared to the low risk group. Only 10 patients, which represent 1.2% of all the patients, had decreased visual acuity on the last follow up, with significantly more injuries of high-velocity mechanism and anterior chamber involvement, in comparison to patients with normal visual acuity on the last follow up. Conclusion: High-velocity mechanism by itself, even with normal visual acuity and eye examination by the ED physician, should prompt to consider an urgent ophthalmologist consult. What is Known: •Traumatic eye injuries are an important cause of ocular morbidity in children. • Most injuries can be handled by a trained ED physician, but there are indications for an urgent ophthalmologist consultation. • It is crucial to discriminate between low and high-risk ocular injuries. What is New: • High-velocity mechanisms stand out as the most likely risk factor for final impaired visual acuity. • Normal visual acuity on presentation is not reassuring. • We recommend urgent ophthalmologist consultation in cases of high-velocity injury, even if visual acuity is preserved at presentation.
Authors: Eleftheria Matsa; Junxin Shi; Krista K Wheeler; Tara McCarthy; Mary Lou McGregor; Julie C Leonard Journal: JAMA Ophthalmol Date: 2018-08-01 Impact factor: 7.389
Authors: Nathan Kuppermann; James F Holmes; Peter S Dayan; John D Hoyle; Shireen M Atabaki; Richard Holubkov; Frances M Nadel; David Monroe; Rachel M Stanley; Dominic A Borgialli; Mohamed K Badawy; Jeff E Schunk; Kimberly S Quayle; Prashant Mahajan; Richard Lichenstein; Kathleen A Lillis; Michael G Tunik; Elizabeth S Jacobs; James M Callahan; Marc H Gorelick; Todd F Glass; Lois K Lee; Michael C Bachman; Arthur Cooper; Elizabeth C Powell; Michael J Gerardi; Kraig A Melville; J Paul Muizelaar; David H Wisner; Sally Jo Zuspan; J Michael Dean; Sandra L Wootton-Gorges Journal: Lancet Date: 2009-09-14 Impact factor: 79.321