2.4 million cases of ocular trauma occur in the United States each year, of which 35% are in patients aged 17 and younger.[endnoteRef:1] Eye injuries are a major cause of disability in all age groups, but their impact in the pediatric population is particularly heightened.[endnoteRef:2] Common causes of pediatric ocular injuries include penetrating trauma, blunt trauma, traffic accidents, and projectile injury.[endnoteRef:3] [endnoteRef:4] [endnoteRef:5] [1: Prevent Blindness America. The Scope of the Eye Injury Problem. 2010. Available from: http://www.preventblindness.org/sites/default/files/national/documents/fact_sheets/FS93_ScopeEyeInjury.pdf ] [2: TGB M, Valbuena M. Epidemiology and visual outcomes of pediatric ocular trauma cases in a tertiary hospital. Philipp J Ophthalmol. 2014;39:27–31 ] [3: Brophy M. Pediatric Eye Injury-Related Hospitalizations in the United States. Pediatrics. 2006;117(6).] [4: M. R. Shoja, A. M. Miratashi. Pediatric ocular trauma. Acta Medica Iranica. 44(2): 125-130; 2006] [5: Gupta A, Rahman I, Leatherbarrow B. Open globe injuries in children: factors predictive of a poor final visual acuity. Eye. 2008;23(3):621-625.]
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,[endnoteRef:6] those with open globe injuries have significantly poorer outcomes with more complications, surgeries, and worse overall prognosis.[endnoteRef:7] [endnoteRef:8] [endnoteRef:9] [6: May DR, Kuhn FP, Morris RE, Witherspoon CD, Danis RP, Matthews GP, et al. The epidemiology of serious eye injuries from the United States eye injury registry. Graefes Arch Clin Exp Ophthalmol. 2000;238:153–7.] [7: Saxena R, Sinha R, Purohit A, Dada T, Vajpayee RB, Azad RV. Pattern of pediatric ocular trauma in India. Indian J Pediatr. 2002;69:863–7.] [8: Lee CH, Su WY, Lee L, Yang ML. Pediatric ocular trauma in Taiwan. Chang Gung Med J. 2008;31:59–65.] [9: Sheard RM, Mireskandari K, Ezra E, Sullivan PM. Vitreoretinal surgery after childhood ocular trauma. Eye (Lond) 2007;21:793–8.]
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.[endnoteRef:10] [10: Li X, Zarbin MA, Bhagat N. Pediatric open globe injury: A review of the literature. J Emerg Trauma Shock. 2015 Oct-Dec; 8(4): 216–223.]
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.[endnoteRef: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.[endnoteRef: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. [11: Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ocular Trauma Score (OTS). Ophthalmol Clin North Am. 2002 Jun; 15(2):163-5.] [12: Acar U, Tok OY, Acar DE, Burcu A, Ornek F. A new ocular trauma score in pediatric penetrating eye injuries. Eye 2011 25; 370–374]
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.[endnoteRef:13] [endnoteRef:14] [endnoteRef:15] Whether a separate pediatric trauma score allows for improved outcome predictions is unknown.[endnoteRef:16] We sought to determine which system best applied to our population 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. [13: Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Ophthalmology 1996; 103(2): 240–243.] [14: Pieramici DJ, Au Eong KG, Sternberg Jr P, Marsh MJ. The prognostic significance of a system for classifying mechanical injuries of the eye (globe) in open-globe injuries. J Trauma 2003; 54(4): 750–754.] [15: Schörkhuber MM, Wackernagel W, Riedl R, et al Ocular Trauma Scores in paediatric open globe injuries British Journal of Ophthalmology 2014;98:664-668.] [16: Sharma HE, Sharma N, Kipioti A. Comment on a new ocular trauma score in pediatric penetrating eye injuries. Eye vol 25, page 1240 (2011)]