David Geffen School of Medicine at UCLA, Los Angeles, CA.
Division of Ophthalmology, California Northstate University College of Medicine, Elk Grove, CA.
Am J Emerg Med. 2014 Mar;32(3):221-4. doi: 10.1016/j.ajem.2013.11.015. Epub 2013 Nov 14.
Ocular trauma is recognized as the leading cause of unilateral blindness. However, few studies to date have focused on the clinical features of hospital-based ocular emergencies. Effectiveness of trauma centers in treating ocular emergencies was compared with treatment in traditional community hospital emergency departments. Demographics, causes, and nature of ocular emergencies, as well as visual outcome in community hospitals emergency departments and trauma centers, were also examined.
Records of 1027 patients with ocular emergencies seen between July 2007 and November 2010 at 3 community hospitals emergency departments and 2 hospitals with level II trauma centers were retrospectively examined. Unpaired t test and Pearson χ(2) test were used to determine statistical significance.
The incidence of patients requiring ophthalmic intervention was 77.2 per 100 000 in the community hospitals and 208.9 per 100 000 in the trauma centers. Rates of ocular emergencies were higher in middle-aged, white men. Orbital fractures were found in 86% of all orbital contusion cases in trauma centers, whereas 66.7% of patients with fall injuries and open globe diagnoses resulted in legal blindness.
The middle-aged, white men are more vulnerable to ocular injuries caused mainly by motor vehicle accidents. The ability of trauma centers to provide comparable increases in vision outcomes, despite treating more severe ocular emergencies, demonstrates the effectiveness of trauma centers. Patients diagnosed as having orbital contusions or who have fall injuries deserve careful evaluation because they are more likely to have more severe sight-threatening injuries.
眼外伤是导致单侧失明的主要原因。然而，迄今为止，很少有研究关注基于医院的眼部急症的临床特征。比较了创伤中心治疗眼部急症的效果与传统社区医院急诊科的治疗效果。还检查了社区医院急诊科和创伤中心的眼部急症的人口统计学、病因和性质以及视觉结局。
回顾性检查了 2007 年 7 月至 2010 年 11 月在 3 家社区医院急诊科和 2 家具有二级创伤中心的医院就诊的 1027 例眼部急症患者的记录。使用未配对 t 检验和 Pearson χ(2)检验确定统计学意义。
社区医院需要眼科干预的患者发病率为每 100 000 人 77.2 例，创伤中心为每 100 000 人 208.9 例。眼部急症的发生率在中年白人男性中较高。在创伤中心，所有眼眶挫伤病例中有 86%发现眼眶骨折，而 66.7%的跌倒伤和开放性眼球诊断患者导致法律失明。
中年白人男性更容易受到主要由机动车事故引起的眼部损伤。尽管治疗更严重的眼部急症，但创伤中心能够提供可比的视力改善，这证明了创伤中心的有效性。诊断为眼眶挫伤或跌倒受伤的患者需要仔细评估，因为他们更有可能有更严重的视力威胁性损伤。
