Source:Pediatric Neurology
Author(s): Ryan Gise, Timothy Truong, Afshin Parsikia, Joyce N. Mbekeani
IntroductionTraumatic visual pathway injuries (VPI) often are associated with severe head trauma and can have profound deleterious effects on developing children and can complicate rehabilitation. We sought to elucidate the epidemiology of pediatric VPI in the US.MethodsA retrospective evaluation of pediatric patients (<21years) with VPI, submitted to the NTDB (2008-2014), was conducted using ICD-9CM codes. Statistical analysis was performed with SPSS software. Variables were correlated using students' t and Chi-squared tests and logistic regression analyses. Statistical significance was set at p<0.05.Results970 (1.7%) of 58,765 pediatric patients admitted with ocular injuries had VPI. The majority were male (69.2%) and the mean (SD) age was 11.6(7.2) years. Traumatic optic neuropathy (TON) was the most common (86.1%) VPI and had the greatest odds of occurring with oculomotor nerve injury (OR=3.84, 95%CI=2.18-6.74; p<0.001). Associated ocular injuries were open adnexa wounds (87.4%) and orbital fractures (23%). Common mechanisms were motor vehicle occupant (MVTO) (21.5%) and firearms (15.6%). MVTO were most likely in Whites (OR=1.48, 95%CI=1.08-2.03; p<0.015) and firearms in Blacks (OR=4.86,95%CI=3.34–7.07; p<0.001). In the 0-3year age group, VPI were mostly due to falls (OR=2.88,95%CI=1.77–4.69) while the 19-21year group had the greatest association with firearms (OR=2.65,95%CI=1.79-3.93). Overall mortality was 17.6%.ConclusionsVPI occurred in both major and minor ocular injuries. The clear majority were TON that mostly were associated with oculomotor neuropathy. The common mechanisms, MVTO and firearms, revealed age and race disparity. Although infrequent, VPI may have devastating sequelae and should be considered in pediatric ocular injuries.
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