Motor Vehicle Crash-associated Eye Injuries Presenting to U.S. Emergency Departments

Grayson W. Armstrong, BA; Allison J. Chen, BA; James G. Linakis, MD, PhD; Michael J. Mello, MD, MPH; Paul B. Greenberg, MD

Disclosures

Western J Emerg Med. 2014;15(6):693-700.

Abstract and Introduction

Abstract

Introduction Motor vehicle crashes (MVCs) are a leading cause of injury in the United States (U.S.). Detailed knowledge of MVC eye injuries presenting to U.S. emergency departments (ED) will aid clinicians in diagnosis and management. The objective of the study was to describe the incidence, risk factors, and characteristics of non-fatal motor vehicle crash-associated eye injuries presenting to U.S. EDs from 2001 to 2008.

Methods Retrospective cross-sectional study using the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) from 2001 to 2008 to assess the risk of presenting to an ED with a MVC-associated eye injury in relation to specific occupant characteristics, including age, gender, race/ethnicity, disposition, and occupant (driver/passenger) status.

Results From 2001 to 2008, an estimated 75,028 MVC-associated eye injuries presented to U.S. EDs. The annual rate of ED-treated eye injuries resulting from MVCs declined during this study period. Males accounted for 59.6% of eye injuries (95% confidence interval [CI] 56.2%–63.0%). Rates of eye injury were highest among 15–19 year olds (5.8/10,000 people; CI 4.3–6.0/10,000) and among African Americans (4.5/10,000 people; CI 2.0–7.1/10,000). Drivers of motor vehicles accounted for 62.2% (CI 58.3%–66.1%) of ED-treated MVC eye injuries when occupant status was known. Contusion/Abrasion was the most common diagnosis (61.5%; CI 56.5%–66.4%). Among licensed U.S. drivers, 16–24 year olds had the highest risk (3.7/10,000 licensed drivers; CI 2.6–4.8/10,000).

Conclusion This study reports a decline in the annual incidence of ED-treated MVC-associated eye injuries. The risk of MVC eye injury is greatest among males, 15 to 19 year olds and African Americans.

Introduction

Motor vehicle crashes (MVCs) are one of the leading causes of injuries in the United States (U.S.) and impose a large economic burden on the healthcare system.^[1,2] MVCs present unique eye injury risk factors such as rapid changes in velocity, potential broken glass exposure, airbag deployment, lack of occupant restraint use, and other foreign body exposure.^[3–8] However, recent epidemiological studies of MVCs have not examined ocular injuries presenting to emergency departments (EDs) in the U.S. ( Table 1 ). A better understanding of the risk factors for MVC-related ocular injuries would aid clinicians in the diagnosis and management of MVC eye injury victims. We describe herein the characteristics of MVC-associated eye injuries presenting to United States (U.S.) EDs.

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Next Section

Abstract and Introduction
Methods
Results
Discussion
Limitations
Conclusion
References

Table 1. Recent nationwide studies of motor vehicle crash-associated eye injuries in the United States
Author	Population	Study size (# Eye injuries)	Study design	Variables measured	Conclusions
Armstrong et al (present study)	NEISS-AIP	221,091,934 (75,028)	Retrospective	Characteristics of eye injuries presenting to EDs, occupant status, occupant gender age race/ethnicity disposition	Injury incidence decreasing over time, Increased risk among 15 to 19 year olds, males, African Americans. Decreased risk among 0 to 4 year olds and among elderly
McGwin and Owsley (2005)³	NASS-CDS	66,941,420 (1,200,131)	Retrospective	Characteristics of eye injury, airbag deployment status, seatbelt status, occupant status, occupant gender age height weight, vehicle characteristics	Injury incidence increasing over time, greater risk with airbag deployment, increased age, female, crash severity, high ΔV. Decreased risk with heavier weight occupant or seatbelt use
Duma et al (2005)⁵	NASS-CDS	2,413,347 (82,405)	Retrospective	Characteristics of eye injury, full-powered vs depowered airbag, seatbelt status, occupant status, occupant height age weight seat position, crash ΔV	Depowered airbags have decreased risk of eye injury, greater risk of injury among driver, increased risk with depowered airbag if greater weight or increased ΔV
Duma and Jernigan (2003)¹⁵	NASS-CDS	12,429,580 (24,605)	Retrospective	Characteristics of orbital fractures, airbag deployment status, seatbelt status, occupant status, occupant gender age height weight, crash ΔV	Airbags decrease incidence and severity of orbital fractures
Hansen et al (2003)¹⁶	NASS-CDS	11,494,824 (289,279)	Retrospective	Characteristics of airbag vs non-airbag injuries, age, dynamic modeling of elderly vs young eye injuries	Eye injury incidence and severity increases with increasing age and associated lens stiffness causes increased stresses in ciliary body
Duma et al (2002)⁴	NASS-CDS	10,770,828 (238,263)	Retrospective	Characteristics of eye injury, airbag deployment status, seatbelt status, occupant status, occupant gender age height weight, use of eyewear, crash ΔV	Airbags reduce severity of eye injury but increase rate of corneal abrasions, greater risk of injury among drivers and light weight occupants

The National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the National Automotive Sampling System – Crashworthiness Data System (NASS-CDS) are United States injury datasets. ΔV represents a change in velocity during a motor vehicle crash.

Table 2. Demographics of United States emergency department visits from 2001–2008, including motor vehicle crash and eye injury data.
Characteristic	Sample size	National estimates (95% Confidence Interval)^a	Percent of ED visits	Rate per 10,000
Total ED Visits
Male	2,045,386	121,597,423 (105,544,620–137,650,226)	55.0%	8,394.8
Female	1,627,955	99,450,992 (86,848,538–112,053,445)	45.0%	6,650.0
Unknown	759	43,519 (22,642–64,397)	0.0002%	-
Total	3,674,100	221,091,934 (192,415,800–249,768,068)	100%	7,509.9
Total MVC ED cases
Male	174,335	9,734,788 (8,034,67–11,434,889)	45.3%	672.1
Female	204,542	11,760,691 (9,661,377–13,860,004)	54.7%	786.4
Unknown	85	3,778 (1,603–5,953)	0.0002%	-
Total	378,962	24,499,257 (17,729,204–25,269,310)	100%	730.3
MVA eye Injury cases
Male	763	44,702 (36,534–52,870)	59.6%	3.1
Female	551	30,326 (24,547–36,085)	40.4%	2.0
Total	1,314	75,028 (62,103–87,953)	100%	2.5

^aNational estimates derived utilizing NEISS-AIP weighted frequencies.
^bRate of injury calculated using national population estimates from US Bureau of the Census, January, 2005.
ED, emergency department, MVC, motor vehicle crash, MVA, motor vehical accident

Table 3. Age breakdown of motor vehicle crash-associated eye injuries treated in U.S. emergency departments, 2001–2008.
Age	Sample size	National estimates (95% Confidence Interval)^a	Percent of ED visits	Rate per 10,000 people^b
0 to 19	440	20,773 (16,056–25,489)	27.7%	2.5
20 to 29	310	18,152 (14,792–21,512)	24.2%	4.5
30 to 49	382	23,840 (18,435–29,246)	31.8%	2.8
50 to 69	146	9,964 (7,720–12,208)	13.3%	1.7
70 +	35	2,278 (1,240–3,317)	3.0%	0.9
Unknown	1^c	21.4 (0–64.2)	0.03%	-
Total	1,314	75,028 (62,103–87,953)	100%	2.5

^aNational estimates derived using NEISS-AIP weighted frequencies.
^bRate of injury calculated using national population estimates from US Bureau of the Census, January, 2005.
^cNational estimates based on less than 20 actual cases and may not be statistically stable.
ED, emergency department

Table 4. Rates of motor vehicle crash-associated eye injuries among licensed drivers in the U.S.
Age	Sample size	National estimates (95% Confidence Interval)^a	Rate per 10,000 licensed drivers^d
16–24	160	9,656 (6,839–12,472)	3.7
25–34	134	9,181 (6,853–11,509)	2.5
35–44	104	6,407 (4,303–8,511)	1.6
45–54	85	6,435 (4,499–8,371)	1.6
55–64	42	3,013 (1,815–4,211)	1.1
65–74	10^c	601 (122–1,081)	0.4
75+	8^c	759 (97.4–1,421)	0.6
Total	547	36,222 (28,553–43,891)	1.8

^aNational estimates derived using NEISS-AIP weighted frequencies.
^cNational estimates based on less than 20 actual cases and may not be statistically stable.
^dRate of injury calculated using the number of estimated licensed drivers in the US, estimated by US Department of Transportation Federal Highway Administration, January, 2005.

Table 5. Race and ethnicity breakdown of motor vehicle crash-associated eye injuries treated in U.S. emergency departments, 2001–2008.
Race/ethnicity	Sample size	National estimates (95% Confidence Interval)^a	Percent of ED visits (excluding unknown)	Rate per 10,000 People^b
White Non-Hispanic (NH)	494	33,919 (23,997–43,842)	45.2% (59.6%)	3.1
African American	338	16,284 (7,057–25,512)	21.7% (28.6%)	4.5
Hispanic	105	4,474 (2,153–6,796)	6.0% (7.9%)	1.1
Asian NH	18^c	1,050 (−344–2,444)	1.4% (1.8%)	0.9
American Indian NH	8^c	911 (−724–2,546)	1.2% (1.6%)	4.1
Other NH	12^c	266 (−7.96–540)	0.4% (0.5%)	6.6
Unknown	339	18,123 (8,056–28,190)	24.2%	-

Table 6. Patient and crash characteristics of motor vehicle crash-associated eye injuries treated in U.S. emergency departments, 2001–2008.
Characteristic	Sample size	National estimates (95% Confidence Interval)^a	Percent of ED visits (excluding unknown)
Diagnosis
Contusion/abrasion	843	46,114 (36,592–55,636)	61.5%
Foreign body	227	14,801 (11,632–17,971)	19.7%
Hemorrhage	58	3,095 (1,658–4,531)	4.1%
Laceration	42	2,712 (1,397–4,027)	3.6%
Conjunctivitis	34	2,219 (1,108–3,331)	3.0%
Hematoma	14^c	1,032 (123–1,941)	1.4%
Burn chemical	7^c	693 (26.5–1,359)	0.9%
Puncture	4^c	274 (−51.7–599)	0.4%
Burn not specified	2^c	126 (−108–359)	0.2%
Strain/sprain	1^c	119 (−119–357)	0.2%
Burn thermal	1^c	21.4 (−21.5–64.2)	0.03%
Other	81	3,823 (2,400–5,246)	5.1%
Disposition
Treated/released	1,248	71,201 (58,745–83,656)	94.9%
Hospitalized/transferred/observed	59	3,576 (1,891–5,260)	4.8%
Other^e	7^c	252 (−21–525)	0.3%
Occupant status
Driver	547	36,222 (28,553–43,891)	48.3% (62.2%)
Passenger	453	21,812 (17,069–26,556)	29.1% (37.5%)
Other specified	3^c	162 (−82–407)	0.2% (0.3%)
Unknown/unspecified	311	16,831 (12,743–20,919)	22.4%
Total	1,314	75,028 (62,103–87,953)	100%

^aNational estimates derived using NEISS-AIP weighted frequencies.
^cNational estimates based on less than 20 actual cases and may not be statistically stable.
^e'Other disposition' includes against medical advice/left without being seen and unknown.