2.4 million cases of ocular trauma occur in the United States each year, of which 35% are in patients aged 17 and younger.1 Eye injuries are a major cause of disability in all age groups, but their impact in the pediatric population is particularly heightened.2 Common causes of pediatric ocular injuries include penetrating trauma, blunt trauma, traffic accidents, and projectile injury.3 4 5
The rate of hospitalization for pediatric eye injuries in the United States in 2000 was 8.9 per 100,000 persons 20 years or younger. Males account for 69.7% of the hospitalizations.3-5 Although most children who sustain ocular trauma do not require admission,6 those with open globe injuries have significantly poorer outcomes with more complications, surgeries, and worse overall prognosis.7 8 9
While the most common causes of reduced visual acuity (VA) following trauma in children are amblyopia and corneal opacities, concerning presenting factors are numerous and include young age at presentation, poor initial VA, Zone 3 (posterior) location of injury, wound length, lens involvement, vitreous hemorrhage, retinal detachment, and endophthalmitis.10
Various ocular trauma scoring systems have been developed to allow for prediction of final VA. Kuhn et al developed a system using data from eye registries in the United States and Hungary.11 This Ocular Trauma Score (OTS) has been widely applied to numerous populations across nationalities and ages with well-validated predictive ability. Two criteria in the OTS, presenting VA and relative afferent pupillary defect (RAPD), can be challenging to obtain in children, especially those who have just sustained eye injuries. Therefore, Acar and colleagues developed a pediatric ocular trauma score (POTS) that downplayed presenting VA in its predictive model and removed RAPD.12 The newly developed POTS included patient variables, such as age and location of injury in scoring and provided an equation to allow for scoring when no initial VA could be obtained.
The utility of a system for classification of ocular trauma is important for allowing communication between treating emergency personnel and ophthalmologists and providing information about prognosis.13 14 15 Whether a separate pediatric trauma score allows for improved outcome predictions is unknown.16 We sought to conduct a pilot investigation into which scoring system best achieves this goal using cases of pediatric eye trauma presenting to a major tertiary academic center. We used both Kuhn’s original OTS and Acar’s POTS on all cases of penetrating eye trauma and calculated which system had better prognostic accuracy.