Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Application of pediatric ocular trauma score in pediatric open globe injuries

AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P&#x0003c;0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.

Characteristics and visual outcomes of patients hospitalized for ocular trauma in central China: 2006-2011

AIM: To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region.METHODS: A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed.· RESULTS: This study included 5964 eyes of 5799 patients. The average age was 35.5 ±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59 y age group. Most patients were farmers and workers(51.9%). The most common injuries were firework related(24.5%), road traffic related(24.2%), and work related(15.0%). Among the most common causative agents were firecrackers(24.5%), followed by metal/knife/scissors(21.4%). Most injuries occurred in January(14.2%),February(27.0%), and August(10.0%). There were 8.5%patients with ocular injuries combined with other injuries.The incidence of open ocular injuries(4585 eyes, 76.9%)was higher than closed ocular injuries(939 eyes, 15.7%).The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score(OTS)predicted final visual acuity at non light perception(NLP), 20/200-20/50 and 20/40 with a sensitivity of 100%,and light perception(LP) /hand motion(HM) and 1/200-19/200 with a specificity of 100%.· CONCLUSION: This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.

Predictors of visual outcome in traumatic cataract

Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.

Mechanical Eye Trauma Epidemiology, Prognostic Factors, and Management Controversies—An Update

Purpose of Review: The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. Review Findings: Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. Conclusion: This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.

不同创伤评分系统在爆炸伤伤情评估中的比较

目的探讨适合武器杀伤生物效应评估爆炸伤伤情的创伤评分系统。方法采用某型模拟弹药对开阔地的28只实验兔进行静爆致伤实验,分别使用简明损伤定级标准(abbreviated injury scale,AIS),校正损伤严重度指数(adjusted injury of severity index,ASⅡ)进行伤情判定,研究两种伤情评定方法的优缺点和有效性。结果爆炸距离对ASⅡ评分、AIS评分方法中的损伤严重度评分(injury severity score,ISS)和最大简明损伤定级标准评分(maximal abbreviated injury scale,MAIS)都存在显著影响(P<0.001,P=0.046,P=0.010 6)。ASⅡ、ISS和MAIS评分随着爆炸距离的增加变化率分别为80%、73.6%、54.5%,ASⅡ评分随着距离的增加变化率最大,其次是ISS、MAIS评分。ASⅡ、MAIS和ISS评分与爆炸距离相关系数R分别为0.788 6(P<0.001),0.607 2(P<0.001)和0.566 4(P=0.001 7)。ASⅡ评分与爆炸距离的相关性最好,其次是MAIS、ISS评分。结论ASⅡ评分能有效反映爆炸伤伤情与损伤程度,更适合于武器杀伤生物效应爆炸伤伤情评估。

创伤评分系统在严重创伤患者伤情评估中的应用初探

目的 研究创伤评分系统对严重创伤患者伤情评估的效果.方法 选择2000年1月～2008年12月以腹部损伤为主并进行剖腹手术救治的192例严重创伤患者的临床资料,其中男性146例,女性46例;年龄7～65岁,平均年龄35.1岁.交通事故伤77例,高处坠落伤36例,刀刺伤及其他伤79例.通过创伤评分系统进行创伤评分.根据救治的最终结局,将患者分为存活组和死亡组两组,统计分析并比较小同创伤评分指标的差异.结果 两组患者在年龄、呼吸指标差异无统计学意义,但在其他临床观察指标及创伤评分指标差异均有统计学意义（P＜0.05）.结论 创伤评分系统是对创伤患者的损伤严重程度和结局进行评估的有效方法,值得进一步推广应用.

六部分骨折分型在减少和预防股骨转子部骨折患者围手术期风险中的应用

目的探讨六部分骨折分型在减少和预防股骨转子部骨折患者围手术期风险中的应用价值。方法选取2012年3月至2016年4月期间收治的318例股骨转子部骨折手术患者,按照随机数字表法将所有患者随机分为三组,对三组患者分别进行AO分型和改良Evans分型以及六部分骨折分型处理。对于改良Evans分型中的IA、IB型骨折患者以及AO分型中A1、A2.1型患者和六部分骨折分型中顺粗隆间骨折的两部分骨折患者均采用股骨近端防旋髓内钉(PFNA)、动力髋螺钉(DHS)以及Gamma钉进行手术;而对于改良Evans分型以及AO分型、六部分骨折分型中稳定型之外的患者则一律采用PFNA、Gamma钉、髋关节置换进行手术。分析比较三种不同分型患者的出血量、手术时间、术后并发症发生情况、负重时间、Harris评分、骨折愈合时间以及住院时间等指标。结果 DHS组的对比中,六部分骨折分型患者的手术时间和出血量以及骨折愈合时间等均低于改良Evans分型和AO分型的患者(P<0.05),而六部分骨折分型患者的Harris评分则明显高于另外两种分型患者(P<0.05),三组患者的负重时间和住院时间则无显著差异(P>0.05)。六部分骨折分型与另外两种分型在PFNA组和Gamma组中的手术时间、住院时间、骨折愈合时间、负重时间、Harris评分方面均无显著差异(P>0.05)。六部分骨折分型患者在内置物并发症以及心血管系统、活动性出血、泌尿系感染、肺炎、压疮、下肢深静脉血栓等方面的并发症发生率均显著低于另外两种分型患者(P<0.05)。结论六部分骨折分型能够比改良Evans分型和AO分型更加准确地反映患者股骨转子部骨折情况,在内固定方式的选择上具有更高的指导作用,同时也能较好地改善患者病情和治疗预后。

标准化沟通模式联合眼外伤评分系统在野战医疗所救治眼战伤中的应用

背景战场上眼战伤发生率较高,复杂眼战伤应给予准确评估并及时处置,为下一步后送治疗提供准确信息和手术依据,因此探索眼战伤的紧急救治对于提升部队作战能力有重要意义。目的探讨标准化沟通模式SBAR[Situation(现状)-Background(背景)-Assessment(评估)-Recommendation(建议)]联合眼创伤评分系统(ocular trauma score,OTS)建立的标准化模板,在野战医疗所对眼战伤进行标准化分级,是否能给救治过程提供客观准确的信息,指导制定更为合理的救治和后送方案。方法我院野战医疗所在驻训演练过程中联合应用SBAR沟通模式和OTS评分系统,设计适合我院野战医疗所检伤救治流程规范的模板,通过检伤组自评和救治组互评的方式,对比模板应用前后救治主动性、救治时效性、救治准确性、交接流畅性、信息完整性、工作满意度等情况。结果应用SBAR眼外伤检伤标准模板后检伤分类组自评救治主动性(84.53±4.52 vs 78.87±5.00)、救治时效性(86.80±4.089 vs 82.00±4.068)、救治准确性(87.60±4.215 vs 83.37±4.311)、病历信息与收容救治组交接时的流畅性(89.20±4.06 vs 83.97±4.77)、信息完整性(90.00±4.39 vs 83.23±4.61)、工作满意度(91.50±3.93 vs 85.90±4.41)均优于使用前,差异有统计学意义(P均<0.05)。结论SBAR沟通模式联合OTS评分应用于野战医疗所眼部损伤的伤员救治,能够优化救治流程,提高医护人员满意度,值得推广。

移动创伤评分系统在卫生应急救援中的应用

为了应对大规模自然群体灾害发生时外伤患者的伤情分析与患者识别,通过创伤评分系统,引入移动软件技术对外伤患者进行评分,以实现快速、准确、便捷的患者病历资料传输,准确的识别患者并大幅度提高患者抢救效率。

入院SIRS评分预测多发伤患者预后的临床分析

目的探讨多发伤患者入院SIRS评分与其预后的相关性。方法对我院2003年1月—2006年12月收治的883例多发伤患者进行入院SIRS和ISS评分,分析多发伤病死率与SIRS评分的关系,评价SIRS评分与多发伤患者病死率、入ICU率、休克率、住院时间长短等预后的相关性。结果多发伤的休克率、入住ICU率、平均住院天数和病死率均随着SIRS分值的增加而增高的趋势(P<0.01);多发伤后SIRS发生率为37.15%,SIRS组患者与非SIRS组比较病死率明显增加。结论入院SIRS评分操作简单,有独立预测多发伤患者预后的价值。

颌面创伤资料数据库系统的设计与开发

目的 设计开发有专科特色的颌面创伤数据库系统 ,以提高颌面创伤的研究水平。方法 使用C/S和B/S两种数据库结构 ,选用SQLServer 2 0 0 0搭建数据库平台 ,C ++Builder 6 .0作为数据库管理系统的开发工具。完成了创伤患者信息管理、用户管理、资料审核、信息检索、资料统计分析、病例回访、系统维护 7个功能模块。结果 通过该系统可以将颌面创伤患者的伤因、伤情、救治情况录入数据库 ,进行检索、统计分析和创伤评分研究 ,通过网络可实现颌面创伤的协作研究。结论 系统稳定性、安全性、兼容性可靠 ,专科特色明显 ,统计分析准确 ,可辅助通过网络收集研究标准化的创伤病例资料。

多发伤并发全身炎症反应综合征临床危险因素分析

目的探讨多发伤并发全身炎症反应综合征（SIRS）临床危险因素，为早期预防治疗全身炎症反应综合征提供依据。方法2009年2月至2013年2月急诊就诊多发伤患者289例，合并全身炎症反应综合征为观察组，未合并炎性反应综合征为对照组。病例的评估采用急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分和损伤严重度评分（ISS）。CD4^＋，CD8^＋水平测量采用流式细胞仪。胰岛素（Insulin，INS）水平测量采用化学发光法。C-反应蛋白（Creactive protein，CRP）测量采用免疫比浊法。肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白细胞介素10（intefleukin-10，IL-10）、白细胞介素-6（interleukin-6，IL-6）的测定采用酶联免疫吸附双抗体夹心法。结果DIC、ISS、APACHEⅡ评分两组间差异有统计学意义（Х^2=5．67，t=-2．63、2．51，P〈0．05）；IL-6、IL-10、INS两组间差异有统计学意义（t=2．34、2．18、2．08，P〈0．05）；ISS、APACHEⅡ、DIC、IL-6、IL-10、INS是多发伤并发全身炎症反应综合征的危险因素，其中IL-10的OR值最大，其次为DIC。结论ISS、APACHEⅡ、DIC、IL-6、IL-10、INS是多发伤并发全身炎症反应综合征的危险因素，治疗多发伤时应注意这6种影响因素的变化。

MEWS评分系统支持的护理管理对急性脑外伤患者的干预价值

目的观察并分析急性脑外伤患者接受基于MEWS评分系统的护理管理模式的护理效果及护理风险事件的发生概率。方法使用数字双盲法将2018年6月至2019年7月期间本院收治的80例急性脑外伤患者分为对照组与研究组,分别给予常规干预、常规干预联合基于MEWS评分系统的护理管理,两组患者对比护理效果及护理风险事件的发生概率。结果两组神经功能(NIHSS)评分干预前比较差异无统计学意义(P>0.05),干预1个月及3个月后对照组NIHSS评分均显著高于研究组[(6.8±2.0)分比(5.0±1.7)分、(5.1±1.5)分比(3.9±1.0)分],两组比较差异均有统计学意义(均P<0.05);两组患者干预前日常生活能力情况(Bathel)评分比较差异无统计学意义(P>0.05),干预1个月及3个月后研究组Bathel评分均高于对照组(均P<0.05);干预后研究组护理风险事件总发生率低于对照组(5.0%比27.5%),两组比较差异有统计学意义(P<0.05)。结论急性脑外伤患者急救过程中行基于MEWS评分系统的护理管理,可有效改善患者神经功能缺损情况,增强日常生活能力,减少护理风险事件的发生,该护理模式在临床上应加大推广应用力度。

不同评分系统对严重外伤患者预后的评估价值对比

目的对比不同评分系统对严重外伤患者预后的评估价值。方法对海南医学院附属医院于2012年9月至2013年9月收治的400例严重外伤患者分别进行急性生理和慢性健康状况评分Ⅱ(APACHEⅡ评分)、改良早期预警评分(MEWS)及简单临床评分(SCS),对比三种评分系统对患者预后的评估效果。结果随着病死率的上升,三种评分亦随之逐渐升高。APACHEⅡ评分的误差值最小(0.026),MEWS评分的误差值最大(0.034);APACHE评Ⅱ分的ROC曲线下面积最大(0.866),MEWS评分的曲线下面积最小(0.749)。结论 MEWS评分、APACHEⅡ评分及SCS评分均可以有效地对严重外伤患者的预后进行评估,但APACHEⅡ评分的评估准确度最高,MEWS评分准确度最低。而SCS评分系统操作方便、快速、准确度较好,更有利于早期对严重外伤患者预后的评估。

颌面部创伤信息管理及评估系统的建立

目的探讨具有专科特色的颌面部创伤信息管理及评估系统的建立方法.方法采用Visual Studio2007和SQL Server2007软件在Windows XP Professional操作系统下建立颌面部创伤信息管理及评估系统.结果通过该系统可以实现将颌面创伤患者资料录入,进行检索、分析、创伤评分研究以及术后结果评分.结论该系统专科数据采集全面,查询方便,通过该系统的创伤评分及术后评分可实现对创伤诊治的客观评估.

基于ICNSS评分系统的分层管理对ICU脑外伤患者的影响

目的:探讨基于ICNSS评分系统的分层管理对ICU脑外伤患者的影响。方法:选取2013年1月~2015年3月54例ICU脑外伤患者为对照组,给予常规管理;选取2015年4月~2017年6月54例ICU脑外伤患者为观察组,实施基于ICNSS评分系统的分层管理。比较两组临床效果。结果:两组并发症发生率、护理质量评分及美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷评分(GCS)、Fugl-Meyer运动功能评定量表评分、Barthel指数评分比较差异均有统计学意义(P<0.05)。结论:基于ICNSS评分系统的分层管理可降低ICU脑外伤患者并发症发生率,提高护理质量,改善患者预后。

134例眼球外伤住院军人情况分析

目的对住院军人眼球外伤类型分布情况进行统计,探讨不同类型眼球外伤致伤原因、受伤场合、就诊时间和眼球外伤预后情况。方法选取自2016年1月至2019年6月于北部战区总医院因眼球外伤住院的军人患者134例,根据眼创伤国际标准进行眼球外伤类型分类,采用眼外伤评分(OTS)对患者预后视力进行分级。统计患者致伤原因、受伤场合、就诊时间和眼球外伤预后情况。结果本组患者中,机械性眼球外伤129例(96.3%)。其中闭合性眼球外伤93例,包括钝挫伤90例,板层裂伤3例;开放性眼球外伤36例,包括破裂伤14例,角膜和(或)巩膜裂伤22例(穿通伤3例、贯通伤10例、球内异物9例)。本组患者中,非机械性眼球外伤5例(3.7%),包括化学伤3例,辐射伤2例。闭合性眼球外伤主要发生在工作训练和业余生活中,分别为46例(49.5%)、30例(32.3%);开放性眼球外伤主要发生在工作非训练中,为23例(63.9%);非机械性眼球外伤主要发生在工作非训练中,为4例(80.0%)。采用Fisher确切法对受伤类型与受伤场合进行交叉列表比较,差异有统计学意义(P<0.05)。闭合性眼球外伤主要致伤原因为四肢碰撞,共46例(49.5%);开放性眼球外伤主要致伤原因为炮弹炸伤,共20例(55.6%);非机械性眼球外伤主要致伤原因为化学物和光刺激,分别为3例(60.0%)、2例(40.0%)。采用Fisher确切法对受伤类型与致伤原因进行交叉列表比较,差异有统计学意义(P<0.05)。治疗后,患者平均视力为LogMAR(0.88±0.11),显著高于治疗前的LogMAR(0.54±0.09),差异有统计学意义(P<0.05)。闭合性眼球外伤平均就诊时间19 d,开放性眼球外伤平均就诊时间3 d,非机械性眼球外伤平均就诊时间2 d。Kruskal-Wallis检验显示,3组间平均就诊时间比较,差异有统计学意义(P<0.05)。开放性眼球外伤≤24 h就诊患者治疗后平均视力LogMAR(1.05±0.29);开放性眼球外伤>24 h就诊患者治疗后平均视力LogMAR(1.29±0.49),差异无统计学意义(P>0.05)。结论现代军人眼球外伤多在工作训练和业余生活中发生,预后视力较好;工作非训练中发生相对少,但预后视力较差。在工作中可推广使用护目镜以避免受伤,外伤发生后应及早就医。