Abstract
BackgroundTo determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry.MethodsThe TraumaRegister DGU® was searched for patients suffering from serious trauma with a Maximum Abbreviated Injury Scale (AIS) ≥ 3 between 2002 and 2015 in Europe. After excluding cases without significant head injury defined by an AIS ≥ 2, groups were built regarding the existence of a concomitant damage to the prechiasmatic optic system comprising globe and optic nerve. Group comparisons were performed with respect to demographic, etiological, clinical and outcome characteristics.Results2.2% (1901/84,627) of seriously injured patients with concomitant head trauma presented with additional VSI. These subjects tended to be younger (mean age 44.7 versus 50.9 years) and were more likely of male gender (74.8% versus 70.0%) compared to their counterparts without VSI. The most frequent trauma etiologies were car accidents in VSI patients (28.5%) and falls in the control group (43.2%). VSI cases were prone to additional soft tissue trauma of the head, skull and orbit fractures as well as pneumocephalus. Primary treatment duration was significantly longer in the VSI cohort (mean 23.3 versus 20.5 days) along with higher treatment costs and a larger proportion of patients with moderate or severe impairment at hospital discharge despite there being a similar average injury severity at admission in both groups.ConclusionsA substantial proportion of patients with head injury suffers from additional VSI. The correlation between VSI and prolonged hospitalization, increased direct treatment expenditures, and having a higher probability of posttraumatic impairment demonstrates the substantial socioeconomic relevance of these types of injuries.
Highlights
To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry
In Germany, annual incidence rates of 302 and 30.5 per 100,000 inhabitants have been determined for mild and severe head trauma previously [6, 7], but there is a general lack of information on the frequency of patients suffering from head and face trauma with additional injury to the prechiasmatic visual system (VSI) which comprises of the globe and the optic nerve
Prevalence of eye and optic nerve injuries in moderate to severe head trauma patients 2.2% (CI 2.1–2.3%) of the total study population (n = 84,627) comprised of seriously injured patients with additional moderate to severe head trauma suffered from accompanying visual system injury (VSI)
Summary
To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry. In Germany, annual incidence rates of 302 and 30.5 per 100,000 inhabitants have been determined for mild and severe head trauma previously [6, 7], but there is a general lack of information on the frequency of patients suffering from head and face trauma with additional injury to the prechiasmatic visual system (VSI) which comprises of the globe and the optic nerve. To the best of our knowledge, this is the firsttime report aiming to determine the prevalence and characteristics of VSI among seriously injured patients with concomitant moderate to severe head trauma in the Central European setting by means of a large multinational trauma registry
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