Citation

Iftikhar M, Canner JK, Hall L, Ahmad M, Srikumaran D, Woreta FA. Ophthalmology 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, American Academy of Ophthalmology, Publisher Elsevier Publishing)

DOI

10.1016/j.ophtha.2020.06.065

PMID

32659309

Abstract

OBJECTIVE: To examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States (U.S.).

DESIGN: Retrospective, longitudinal study of U.S. nationwide emergency department (ED) data.

SUBJECTS: ED patients.

METHODS: The Nationwide Emergency Department Sample, a representative sample of all hospital-based ED's in the U.S., was used to identify and describe ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017. Linear regression was used to estimate the trends in annual incidence and mean inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission.

MAIN OUTCOMES MEASURES: Incidence, injury mechanisms, demographics, clinical characteristics, concomitant ocular injuries, disposition, and inflation-adjusted ED charges.

RESULTS: From 2006 to 2017, there were an estimated 350,379 ED visits in the U.S. with a primary diagnosis of orbital floor fracture. The incidence increased by 47% over the study period (p<0.001); from 7.7 (95% CI: 6.9-8.5) to 11.3 (95% CI: 10-12.6) per 100,000 population. The majority were males (67%) aged 21-44 years (46%) from low-income households (32%). The most common cause of injury was assault (43%), which was most frequent in young adults (65%) and increased modestly over the study period (3.5 to 4.5 per 100,000 population; p=0.02). The second most common cause was fall (26%), which was most frequent in patients ≥65 years (86%), and more than doubled over the study period (1.6 to 3.5 per 100,000 population; p<0.001). The hospitalization rate was 14%, with a higher likelihood of inpatient admission for patients ≥65 years (OR: 2.21; 95% CI: 1.99-2.46; p<0.001) and those with falls (OR: 1.54; 95% CI: 1.27-1.86; p<0.001). The total inflation-adjusted ED charges for all visits over the study period exceeded $2 billion, with the mean charge per visit increasing 48% (p<0.001); from $5,881(95% CI: $5,499-6,263) to $8,728 (95%: $8,074-9,382).

CONCLUSIONS: Orbital floor fractures are becoming an increasingly common and costly injury in the U.S. Preventive strategies aimed at individuals at risk of assault as well as older people at risk of falls will be crucial to mitigating the burden of orbital fractures on the healthcare system.

Language: en