Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

INTRODUCTION

Ocular trauma is a major cause of monocular blindness in developed countries

. Approximately 2.4 million cases of ocular trauma occur in the United States annually, of which 35% are in patients aged 17 and younger

. Eye trauma to pediatric patients results in specific challenges and amblyopia among children seven years of age or younger is commonly reported

.

被告:The first，that Opupa,send the phone number to Nigeria to prosecute.(首先，那個Opupa,把電話號碼送回尼日利亞去起訴。)

SUBJECTS AND METHODS

Ocular trauma is one of major etiologies of monocular and visual impairment in all part of the world and it is widely reported that 90% of ocular trauma are preventable

.About 20%-59% of all ocular trauma occur in children

.This is the first study to examine outcomes from globe injuries in Indonesia and provide important information about the predictive value of each scores.

Birmingham Eye Trauma Terminology System (BETTS)defines globe injuries as closed globe injuries (CGI) and open globe injuries (OGI)

. Ocular Trauma Score (OTS)has been widely applied to predict visual outcome

. Two criteria in the OTS, can be challenging to ascertain in injured children, presenting visual acuity (VA) and relative afferent pupillary defect (RAPD)

. Acar

developed Pediatric Ocular Trauma Score (POTS) which reduces the influence of presenting VA in its predictive model and removes RAPD. The prognoses for OGI’s has improved tremendously in the last decades

. The aim of this study was to evaluate the predictive value and applicability of both OTS and POTS for CGI and OGI’s in pediatric presenting to a tertiary eye hospital in Jakarta, Indonesia.

“一言為定！”唐小果一聽，想也不想就答應了，“你得保證給我一書包的糖作為報酬！”身為人類，拯救幾個糖人簡直輕而易舉！這樣不僅能得到很多糖，還會被當做超級英雄崇拜！光想想就激動不已。

For our retrospective study, Electronic Medical Records (EMR) of all cases of pediatric globe injuries presenting to Jakarta Eye Center (JEC) Eye Hospitals between 2012 and 2019 were collected. Patients were identified through EMR searching for the International Classification of Diseases,Tenth Revision, Clinical Modification (ICD-10-CM) codes including S04, S05 (S05.0-S05.9), and S09. Children were defined as individuals 0-18 years of age.

Patient records were reviewed to determine age, gender,initial and final VA. Patients who had VA data for six months following initial trauma were included in analysis. The authors classified the eye injuries in accordance with BETTS and OTS Classification Group by Kuhn

. The OTS and POTS parameters were calculated and analyzed for their predictions on visual outcome included initial VA, globe rupture,endophthalmitis, perforating injury, retinal detachment, RAPD,age, wound location, concomitant eye pathologies including iris prolapse, hyphema, organic/unclean injury, delay of surgery >48h, traumatic cataract, vitreous hemorrhage. POTS was calculated and evaluated for the age group of 0-15-year-old(for which it was designed). Both scores were used to assign patients a Group number between 1 and 5. Group 1 represents the poorest prognosis and 5 the best. Association between Group and final VA was examined. The applicability of OTS and POTS was assessed.

對現有教學的滿意程度較好的占22%（見圖2），很好的為 0%，而從教學建議上來看（見圖 3），主要是從加強調研的指導工作(占67%），其次是設計課的講學（張 57%）與軟件使用的教學（占 56%），而理論教學與研究能力的提高占比低（分別為43%與 35%），可見學生更多的是期望以實用為主導，即使是高年級與研究生也是期望在用中學，而不是依靠理論教學來提高。

Analysis of OTS parameters indicated that initial VA (

<0.001)and globe rupture (

=0.008) predicted worse visual outcome.Using POTS, initial VA (

<0.001), traumatic cataract(

<0.001), organic/unclean wound (

=0.001), delay of surgery(

=0.001), and iris prolapse (

=0.003) had a significant impact on predictive visual outcome. By using Spearman’scorrelation, we described

-value of each predictive value of OTS and POTS parameter (Tables 3, 4).

RESULTS

Initial uncorrected visual acuity (UCVA) was able to be obtained in 62 children with mean 0.832±0.904 logMAR (range 0-3.0 logMAR). Overall, the majority patients had UCVA of ≥20/40 on the affected eye at presentation (29/62, 34.5%;Figure 1). Best-corrected visual acuity (BCVA) at presentation was recorded in 58 patients.

A total of 84 patients (eyes) met the inclusion criteria over the eight years period examined. CGI represented the majority of patients (59/84, 70.2%) and OGI was reported in 29.8% (25/84)patients. The 11-18 years old (35/84, 41.7%) represented the largest proportion of injured patients. A higher proportion of boys (62/84, 73.8%) than girls were represented in the data across all age groups. Age group, gender and type of injury are described in Table 1.

Of 62 children were assigned to the OTS group and 69 children were assigned to the POTS group (Table 2). A strong correlation between OTS, POTS and final visual outcome was identified (Spearman’s correlation:

=-0.798,

<0.001;

=-0.612,

<0.001, respectively). Using linear regression ANOVA, we observed that initial VA was a significant predictor of final VA (

=53.737,

<0.001,

=0.599). Not only OTS was a significant predictor of final VA (

=32.408,

<0.001,

=0.474), but also POTS (

=21.876,

<0.001,

=0.406); Figure 2). Fifteen (17.9%) patients had improved final VA compared to presenting VA, 19 (22.6%) remained the same and 6 (7.1%) had reduced vision.

All data was entered into Microsoft Excel spreadsheet. Snellen VA was converted to logarithm of minimal angle resolution (logMAR) equivalent for statistical analysis. Statistical analysis was performed using SPSS Statistics for Mac version.25 (SPSS Inc., Chicago, Illinois,USA). Linear regression of analysis of variance (ANOVA)was used to evaluate the predictive value of initial VA to final VA. The Spearman’s rank correlation coefficient was used to evaluate the predictive value of OTS and POTS with final VA. A

-value of <0.01 was considered statistically significant. Normally distributed parameters are reported as mean±standard deviation (SD).

方法：取艾葉50克，放入沸水中煎煮約15分鐘，待水溫稍低后，就可以把腳放入藥液浸泡，每次浸泡 15～20分鐘，水涼后可加入熱水。

This study was approved by Ethics Committee of Medical and Health Research Ethics Committee(MHREC) Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada - Dr. Sardjito General Hospital Ref No. KE/FK/0645/EC/2020 and complied with the tenets of the Declaration of Helsinki. Informed consent to participate was obtained from all patients and guardians.

In our study we found a higher proportion of CGI than OGI, a similar pattern was presented in Northern India study

.

However, Barry

and Madan

presented OGIs were the most common injury. Zone I injuries predominance of both OGI and CGI is consistent to other studies

. Despite Zone I involvement was common in our population; this finding is important because the visual outcome of children could be affected and often result in amblyopia. None of perforating injuries were found in this study. Our hospital is a private tertiary eye hospital in Jakarta, Indonesia. The documentation variability could be due to vast differences in cultural, social-economic factors and referral services.

A study in central Maharashtra, India

, reported 6-10 years old children were the mostly affected, whereas in Western Australia

, 0-2 years old was the highest group who suffered the injuries, these findings differ to our study. In our 11-18 years age group predominance, a child is in the period of adolescence, a transition phase to adulthood, they usually involve in many outdoor activities. A male predominance (7:1)is consistent with previous studies

. A possible reasonfor this finding could be boys are more involved than girls in daily activities. They are more curious, fearless, and always explore something new.

Calculating OTS Group, we found that OTS 5 (26/62, 41.9%)was predominant, and all of these were CGI’s. The 2/62(3.2%) patients with OTS 1 were due to an OGI. POTS 4 was predominant (18/69, 26.1%) of which 11/18 were due to CGI and 7/18 patients were due to OGI. Good initial VA and a high OTS were statistically correlated with good final VA in our study, and has been identified previously

.Madan

demonstrated that OGI present more potential for poor visual outcome than CGI, this presented in this study. According to WHO blindness definition

,therefore 11 (13.2%) patients in this study would be defined as legally blind.

OTS parameters showed that initial VA (

<0.001) and globe rupture (

=0.008) were highly associated to visual outcome while Sch?rkhuber

reported initial VA and retinal detachment. POTS parameters showed that initial VA (

<0.001), traumatic cataract (

<0.001) followed by organic/unclean wound (

=0.001), delay of surgery(

=0.001), and iris prolapse (

=0.003) were highly associated with visual outcome. These findings had similar trend in the previous study

.

付江錄是十三師火箭農場的個體工商戶。他先后成立了哈密江盛有限責任公司、哈密鼎舜有限責任公司，在此期間，他還從事過個體運輸和機采棉等工作。無論在何種崗位，他都是干一行愛一行，一心撲在工作上，兢兢業業，勤勤懇懇，一絲不茍，各項工作想在前、干在前，充分起到了模范帶頭作用。他用自己200多萬元的資金幫扶了近40人脫貧致富，其中有8名火箭農場的少數民族兄弟在他的傾情支持下，從一無所有踏上了小康之路。

OTS was more applicable in all age group as it only required six parameters. In contrast to POTS, we could not calculate our patient with age more than 15 years old into category and it required eleven parameters. Injured children might show poor compliance for initial VA examination. Due to lack of initial VA, we had to eliminate our 22 patients into OTS category, in the other hand, we could calculate all scores of initial VA into POTS category by using POTS equation. Recent study by Awidi and Kraus

, they had to eliminated seven patients from OTS calculation due to lack of initial VA, therefore POTS to be more predictive of visual outcome than OTS.While Sch?rkhuber

reported that OTS is reliable prognostic tool for pediatric OGI. Our result indicates that OTS and POTS are accurate to predict final visual outcome,both can be calculated depend on availability of the initial VA and patient’s age.

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