Abstract
Background
Pediatric abusive head trauma (AHT) refers to head injury from intentional blunt force
or violent shaking in children aged five years or less. We sought to evaluate the
epidemiology of ocular injuries in AHT.
Methods
This retrospective analysis of the National Trauma Data Bank (2008 to 2014) identified
children aged five years or less with AHT and ocular injuries using ICD-9-CM codes.
Demographic data, types of ocular and nonocular/head injuries, geographic location,
length of hospital admission, injury severity, and Glasgow Coma scores were tabulated
and analyzed.
Results
A total of 10,545 children were admitted with AHT, and 2550 (24.2%) had associated
ocular injuries; 58.7% were female. The mean age was 0.5 (±1.0) years. Most (85.7%)
were aged one year or less. Common ocular injuries included contusion of eye/adnexa
(73.7%) and retinal edema (59.3%), and common head injuries were subdural hemorrhage
(SDH) (72.8%) and subarachnoid hemorrhage (22.9%). Retinal hemorrhages occurred in
5.3%. About 42.8% of children had injury severity scores greater than 24 (very severe),
and the mortality rate was 19.2%. Children aged one year or less had the greatest
odds of retinal hemorrhages (odds ratio [OR] = 2.44; P = 0.008) and SDH (OR = 1.55; P < 0.001), and the two- to three-year-old group had the greatest odds of contusions
(OR = 1.68; P = 0.001), intracerebral hemorrhages (OR = 1.55; P = 0.002), and mortality (OR = 1.78; P < 0.001). For all ages, SDH occurred most frequently with retinal edema compared
with other ocular injuries (OR = 2.25; P < 0.001).
Conclusions and relevance
Ocular injuries varied with age and were variably associated with nonocular injury.
The youngest group was most frequently affected; however, the two- to three-year-old
group was most likely to succumb to injuries.
Keywords
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Article info
Publication history
Published online: November 12, 2021
Accepted:
November 6,
2021
Received:
May 12,
2021
Footnotes
Disclosure: There were no conflicts of interest or funding sources for this work. Drs. Joyce Mbekeani and Afshin Parsikia had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
