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Original Investigation
January 2019

Changes in the Incidence of Eye Trauma Hospitalizations in the United States From 2001 Through 2014

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 4Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. 2019;137(1):48-56. doi:10.1001/jamaophthalmol.2018.4685
Key Points

Question  What changes have occurred in the incidence of hospitalizations for eye trauma in the United States from 2001 through 2014?

Findings  In a cohort study using the National Inpatient Sample (a representative sample of all US community hospital discharges), the incidence of eye trauma as a primary admitting diagnosis remained constant over time and was more common in men, children, adolescents, nonwhite individuals, and individuals with lower socioeconomic status. Eye trauma as a secondary diagnosis increased because of an increased incidence of falls in elderly individuals.

Meaning  In light of these findings, it is important to increase awareness and develop prevention strategies to limit eye trauma.

Abstract

Importance  Eye trauma is a common cause of vision loss and a substantial public health problem.

Objective  To determine the changes in the incidence of eye trauma hospitalizations in the United States and compare the demographics of affected patients and outcomes of eye trauma as a primary or secondary admitting diagnosis.

Design, Setting, and Participants  This retrospective longitudinal cohort study used the National Inpatient Sample, a representative sample of all US community hospitals, to determine the incidence, characteristics, and causes of primary and secondary inpatient eye trauma admissions from 2001 through 2014. All inpatients with relevant diagnoses were included. Linear regression was used to estimate changes in incidence. Logistic regression was used to compare demographics and outcomes between primary and secondary diagnoses, including age, sex, race, income, primary payer, region, year of admission, length of stay, cost, and disposition at discharge.

Exposures  Eye trauma.

Main Outcomes and Measures  Incidence and characteristics of inpatient primary and secondary eye trauma.

Results  From 2001 to 2014, there were an estimated 939 608 inpatient admissions (of whom 556 886 were male patients [59.3%]; overall mean [SD] age, 49.4 [25.2] years) in the United States because of eye trauma diagnoses, with 778 967 of these (82.9%) as a secondary diagnosis. The incidence of primary eye trauma decreased from 3.9 to 3.0 per 100 000 population (difference, 0.9 [95% CI, 0.2-1.6] per 100 000 population; P = .001). The incidence of eye trauma as a secondary admitting diagnosis increased from 14.5 to 19.0 per 100 000 population (difference, 4.5 [95% CI, 1.9-7.2] per 100 000 population; P = .004). This was largely attributed to an increasing number of falls in individuals older than 65 years. The most frequent diagnosis was orbital fracture (64 149 [39.9%]) for primary trauma and contusion of eye and adnexa (19 301 [37.8%]) for secondary trauma. Primary trauma was more common in children (adjusted odds ratio [aOR], 2.21 [95% CI, 2.09-2.32]) and adolescents (aOR, 1.25 [95% CI, 1.19-1.32]) than adults (reference), African American individuals (aOR, 1.89 [95% CI, 1.81-1.97]) and Hispanic individuals (aOR, 1.52 [95% CI, 1.45-1.59]) than white individuals, and uninsured patients (aOR, 1.14 [95% CI, 1.07-1.22]) and those receiving Medicaid (aOR, 1.12 [95% CI, 1.05-1.19]) than Medicare beneficiaries. Patients with a primary diagnosis were more likely to have a stay of less than 3 days (patients with a primary diagnosis: 101 796 [63.4%]; secondary diagnosis: 274 538 [35.2%]), more likely to have costs in the lowest quartile (patients with a primary diagnosis: 51 212 [31.9%]; secondary diagnosis: 166 260 [21.3%]), and less likely to die (patients with a primary diagnosis: 526 [0.3%]; secondary diagnosis: 20 929 [2.7%]).

Conclusions and Relevance  These findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the development and implementation of effective preventive strategies. Many of these patients are seen in ophthalmology practices where proactive risk assessment and counseling can play a critical role.

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