Orbital Fracture Incidence Up in US Emergency Departments

By Lisa Rapaport

August 14, 2020

(Reuters Health) - The incidence of orbital floor fractures presenting to U.S. emergency departments climbed by 47% from 2006 to 2017, a recent study suggests.

Using data from the Nationwide Emergency Department Sample, researchers estimated that over the course of that period, there were 350,379 ED visits with a primary diagnosis of orbital floor fracture, and the incidence rose from 7.7 to 11.3 per 100,000 population.

As these injuries became more common, costs also soared, with the mean charge per visit rising from $5,881 to $8,074.

Assault accounted for the most cases (43%) and happened most often among young adults (65%). These climbed from 3.5 to 4.5 per 100,000 population during the study period.

Falls, the second most common cause (26%), happened most often among patients 65 and older (86%) and more than doubled during the study period, from 1.6 to 3.5 per 100,000 population.

"Importantly, our study highlights that it is not simply an aging population that is causing the increase," said senior author Dr. Fasika Woreta, director of the Eye Trauma Center at the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore.

"Rather, it is an increase in the rate of falls itself, which means that more people are falling than before," Dr. Woreta said by email. "The majority of these people are elderly and have chronic medical problems, which can account for some of the increased costs of treating their injuries."

To address this increasing risk of fall-related orbital floor fractures, older adults should be screened for fall risk annually, Dr. Woreta said by email.

"Other specialties, including ophthalmology, should also incorporate fall risk assessment as part of their routine work-up and ensure that patients are educated about the risk factors associated with falls as well as the resources available to minimize their risk," Dr. Woreta said.

One limitation of the study is that hospital administrative data doesn't provide detailed clinical information such as injury severity or visual outcomes from orbital floor fractures, the study team notes in Ophthalmology.

"Prevention of these injuries is centered around preventing trauma to the eye; unfortunately, this is difficult as the main causes of these injuries are interpersonal violence and falls," said Dr. James Allison of Newcastle University in Newcastle upon Tyne, in the U.K., who recently co-authored a paper on prediction of orbital fractures.

"Sports and workplace injuries are not an infrequent cause of orbital floor fractures, and proper protective equipment may be helpful in prevention where this is the case," Dr. Allison, who wasn't involved in the study, said by email. "These fractures can cause reduced vision in one eye or double vision (particularly when looking in a certain direction) and it is important that injuries to the eye are assessed by a competent clinician to prevent permanent damage."

SOURCE: https://bit.ly/3fYTggO Ophthalmology, online July 10, 2020.