Harvard Department of Ophthalmology, Massachusetts Eye and Ear, Boston.
Isaiah Giese, California Pacific Medical Center, San Francisco, California.
JAMA Ophthalmol. 2021 Jan 1;139(1):77-83. doi: 10.1001/jamaophthalmol.2020.5108.
Orbital fractures are common in ocular trauma, and there is a need to develop predictive tools to estimate risk of concurrent ocular injury.
To identify clinical and radiographic features that are associated with increased risk of substantial ocular injury in the setting of orbital fracture.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective consecutive case series of patients who sustained orbital fractures between 2012 and 2018. Examinations were done at 1 of 2 level 1 trauma centers in the emergency or inpatient setting. A total of 430 consecutive patients (500 eyes) between 2012 and 2017 met inclusion criteria for the training sample. After building a predictive model, 88 additional consecutive patients (97 eyes) between 2017 and 2018 who met inclusion criteria were collected as a test sample.
The primary outcome measure was substantial ocular injury distinct from orbital fracture.
The mean age of our patient population was 53.5 years (range, 16-100 years). The overall rate of substantial ocular injury was 20.4%, and the rate of injury requiring immediate ophthalmic attention was 14.4%. Five variables were found to be associated with increased risk of substantial ocular injury: blunt trauma with a foreign object (odds ratio [OR], 19.4; 95% CI, 6.3-64.1; P < .001), inability to count fingers (OR, 10.1; 95% CI, 2.8-41.1; P = .002), roof fracture (OR, 9.1; 95% CI, 2.8-30.0; P = .002), diplopia on primary gaze (OR, 6.7; 95% CI, 1.7-25.1; P = .003), and conjunctival hemorrhage or chemosis (OR, 4.2; 95% CI, 2.2-8.5; P < .001). The results were translated into a bedside tool that was tested in an independent group of eyes (n = 97) and found to be associated with substantial ocular injury with a 95% sensitivity (95% CI, 77.2-99.9), 40% specificity (95% CI, 28.9-52.0), 31.8% positive predictive value (95% CI, 27.5-36.5), and 96.8% negative predictive value (95% CI, 81.3-99.5).
A minority of patients with an orbital fracture had a substantial ocular injury. Certain radiographic and clinical findings were associated with substantial ocular injury. Testing of the algorithm in prospective longitudinal settings appears warranted.
眼眶骨折在眼部创伤中很常见，因此需要开发预测工具来估计并发眼部损伤的风险。
确定与眼眶骨折情况下显著眼部损伤风险增加相关的临床和影像学特征。
设计、地点和参与者：这是一项回顾性连续病例系列研究，纳入了 2012 年至 2018 年间发生眼眶骨折的患者。检查在 2 个 1 级创伤中心的急诊或住院环境中进行。共有 2012 年至 2017 年符合纳入标准的 430 例连续患者（500 只眼）纳入训练样本。在建立预测模型后，又纳入了 2017 年至 2018 年间符合纳入标准的 88 例连续患者（97 只眼）作为测试样本。
主要结局指标是与眼眶骨折不同的显著眼部损伤。
我们的患者人群平均年龄为 53.5 岁（范围，16-100 岁）。总体显著眼部损伤发生率为 20.4%，需要立即眼科治疗的损伤发生率为 14.4%。有 5 个变量与显著眼部损伤风险增加相关：钝挫伤伴异物（比值比[OR]，19.4；95%CI，6.3-64.1；P<0.001）、无法指数计数（OR，10.1；95%CI，2.8-41.1；P=0.002）、顶壁骨折（OR，9.1；95%CI，2.8-30.0；P=0.002）、第一眼注视时复视（OR，6.7；95%CI，1.7-25.1；P=0.003）和结膜出血或水肿（OR，4.2；95%CI，2.2-8.5；P<0.001）。这些结果被转化为一种床边工具，并在一组独立的眼睛（n=97）中进行了测试，发现该工具与显著眼部损伤相关，其 95%敏感性（95%CI，77.2-99.9）、40%特异性（95%CI，28.9-52.0）、31.8%阳性预测值（95%CI，27.5-36.5）和 96.8%阴性预测值（95%CI，81.3-99.5）。
少数眼眶骨折患者有显著的眼部损伤。某些影像学和临床发现与显著眼部损伤相关。在前瞻性纵向研究中进一步测试该算法似乎是合理的。
