Over the course of 10 years, ophthalmic trauma visits to the ED totaled 7.3 million and amounted to $14 billion in costs.

Over the course of 10 years, ophthalmic trauma visits to the ED totaled 7.3 million and amounted to $14 billion in costs. Photo: Paige Thompson, OD. Click image to enlarge.

There were more than seven million emergency department (ED) visits for ophthalmic trauma between 2009 and 2018 in the United States, of which males aged 21-44 from low-income households were the most frequent patients, according to a new study in the journal Injury. The mean inflation-adjusted ED charge per visit increased over the 10 years, from $1,333 to $3,187, amounting to over $14 billion total, suggesting preventive efforts and improved outpatient access should be used to alleviate costs and provider burden.

In this retrospective study, researchers examined data from the Nationwide Emergency Department Sample to find the incidence, injury type, demographics and economic burden of ophthalmic trauma. Incidences were higher during the summer months, and the majority of patients were male (65%) and from low-income households (56%). The most common injury type was categorized as superficial (44%), eyelid and orbit wounds (20%) and external foreign bodies (16%). The most expensive injuries were orbital floor fractures ($7,157) and open globe injuries ($6,808), and were responsible for the most admissions (49% and 29%, respectively).

According to the study, 95% of patients were treated and discharged from the ED, demonstrating that many of them may not have required ED-level care. The authors cited data finding nearly half of all eye-related ED visits have been found to be non-emergent diagnoses. “Theoretically, such visits can easily be redirected to eye clinics or urgent care facilities, alleviating the burden on ED resources and reducing overall healthcare costs,” the authors stated. “As such, it is important to increase public awareness regarding access to outpatient eye care on an urgent basis (such as walk-in clinics or same-day appointments). It is also important to train primary care and urgent care providers on how to triage, manage, and/or refer ophthalmic trauma that does not necessarily merit an ED evaluation.”

Economic burden may also be reduced through preventive efforts, suggested the authors. “We believe that prevention efforts should focus on young males residing in low-household income areas. Not only is that the demographic most likely to suffer ophthalmic trauma in general but is also most likely to sustain serious trauma such as orbital floor fracture, which was the most common cause of admission as well as the most expensive injury to treat,” they stated.

Although the authors say the nationally representative sample of 10-year data are among the study’s strengths, its reliance on administrative documentation and lack of occupational and clinical details could inflate some diagnoses. Ultimately, the authors hope this data will guide patient awareness and access to care.

Iftikhar M, Canner JK, Lati A, et al. Epidemiology of ophthalmic trauma in the United States from 2009–2018: A nationwide emergency department sample analysis. Injury. November 17, 2023. [Epub ahead of print.]