Predictors of orbital fractures in pediatric patients
Elman, Daniel M.
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OBJECTIVE: To determine risk factors and examination findings that are predictive of orbital fractures in pediatric patients, in the hope of using the findings to develop a rule for when to obtain a Computerized Tomography Scan (CT). Additionally, we will examine the treatments underwent by patients with confirmed orbital fractures. METHODS: A retrospective cohort study was conducted on patients below the age of 22 who were seen in the Emergency Department (ED) at Boston Children's Hospital (BCH) between January 2009 and May 2013, and underwent Computerized Tomography Scan (CT) for evaluation of orbital fracture. 326 cases were selected for inclusion in analysis. Electronic medical records (EMR) of cases were reviewed and data was collected about mechanism of injury, symptoms, physical exam (PE) findings, diagnosis of orbital fracture, and treatment. Data collected was analyzed using SPSS Statistical Software v.21. Frequency of variables was determined, and chi-square analysis was performed comparing frequencies for patients with orbital fractures to patients without orbital fractures. RESULTS: Of the 326 cases undergoing CT, 133 (40.8%) had radiographic evidence of an orbital fracture. Nausea/vomiting, orbital tenderness, orbital swelling, orbital ecchymosis, and limitation of extraocular movement (EOM) were all identified as statistically significant clinical indicators of orbital fractures. 22 (16.5%) of patients with confirmed orbital fractures underwent surgery, with an average time to surgery of 4.5 days. CONCLUSION: We found that 16.5% of cases with orbital fractures, and only 6.7% of all cases, underwent surgery. We have identified 5 factors that can be used for the development of an evidence-based algorithm for determining when to obtain a CT to rule out an orbital fracture in a pediatric population. We believe that we can use this to improve the evaluation of orbital fractures ED, which in turn will improve the utilization of ED resources, and reduce the exposure of pediatric patients to the risks associated with CT.