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Original Investigation
August 2018

Trends in US Emergency Department Visits for Pediatric Acute Ocular Injury

Author Affiliations
  • 1The Ohio State University College of Medicine, Columbus
  • 2Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
  • 3Department of Ophthalmology, Nationwide Children’s Hospital, Columbus, Ohio
JAMA Ophthalmol. 2018;136(8):895-903. doi:10.1001/jamaophthalmol.2018.2062
Key Points

Question  What were the demographic characteristics and trends of pediatric ocular injuries presenting to emergency departments in the United States from 2006 to 2014, based on data from the Nationwide Emergency Department Sample?

Findings  In this cohort study, 340 218 children from birth to age 17 years presented to Nationwide Emergency Department Sample emergency departments for care of acute ocular injuries, corresponding to 1 533 034 cases nationwide from 2006 to 2014. During the study period, there was a 26.1% decline in ocular injuries observed across all demographic characteristics, mechanisms of injury, and injury patterns.

Meaning  Between 2006 and 2014, pediatric ocular injuries declined in the United States, which may have resulted from prevention efforts.


Importance  There is a lack of literature describing the incidence of pediatric acute ocular injury and associated likelihood of vision loss in the United States. Understanding national pediatric eye injury trends may inform future efforts to prevent ocular trauma.

Objective  To characterize pediatric acute ocular injury in the United States using data from a stratified, national sample of emergency department (ED) visits.

Design, Setting, and Participants  A retrospective cohort study was conducted. Study participants received care at EDs included in the 2006 to 2014 Nationwide Emergency Department Sample, comprising 376 040 children aged 0 to 17 years with acute traumatic ocular injuries. Data were analyzed from June 2016 to March 2018.

Exposures  International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and external-cause-of-injury codes identified children with acute ocular injuries.

Main Outcomes and Measures  Demographic and clinical characteristics of children with acute traumatic ocular injuries were collected and temporal trends in the incidence of ocular injuries by age, risk of vision loss, and mechanism of injury were explored.

Results  In 2014, there were an estimated 163 431 (95% CI, 151 235-175 627) ED visits for pediatric acute ocular injury. Injured children were more often male (63.0%; 95% CI, 62.5-63.5) and in the youngest age category (birth to 4 years, 35.3%; 95% CI, 34.4-36.2; vs 10-14 years, 20.6%; 95% CI, 20.1-21.1). Injuries commonly resulted from a strike to the eye (22.5%; 95% CI, 21.3-23.8) and affected the adnexa (43.7%; 95% CI, 42.7-44.8). Most injuries had a low risk for vision loss (84.2%; 95% CI, 83.5-85.0), with only 1.3% (95% CI, 1.1-1.5) of injuries being high risk. Between 2006 and 2014, pediatric acute ocular injuries decreased by 26.1% (95% CI, −27.0 to −25.0). This decline existed across all patient demographic characteristics, injury patterns, and vision loss categories and for most mechanisms of injury. There were increases during the study in injuries related to sports (12.8%; 95% CI, 5.4-20.2) and household/domestic activities (20.7%; 95% CI, 16.2-25.2). The greatest decrease in high-risk injuries occurred with motor vehicle crashes (−79.8%; 95% CI, −85.8 to −74.9) and guns (−68.5%; 95% CI, −73.5 to −63.6).

Conclusions and Relevance  This study demonstrated a decline in pediatric acute ocular injuries in the United States between 2006 and 2014. However, pediatric acute ocular injuries continue to be prevalent, and understanding these trends can help establish future prevention strategies.