Temporal and Seasonal Trends in Pediatric Eye Trauma in California

Abstract

Purpose: This study aims to evaluate temporal and seasonal trends in pediatric eye trauma based on emergency department (ED) visits in California.

Design: Retrospective, population-based cohort study.

Methods: Children who presented with ocular trauma to EDs in California between 2016 and 2021 were identified using the California Department of Health Care Access and Information datasets and classified by International Classification of Diseases (ICD) diagnosis codes. Poisson regression was used to model yearly incidence and seasonality was assessed.

Results: Among 15,674,366 ED visits by children in California from 2016 to 2021, 160,730 (1.0%) involved a primary or secondary diagnosis of ocular trauma. The mean age at presentation was 7.6 (SD: 5.6) years. The most common diagnoses were ocular adnexal open wound (51.4%) and superficial injury of the eye/adnexa (23.6%). The overall yearly incidence of eye trauma was 3.0 (95% CI: 3.0-3.0) per 1000 children, peaking in 2017 (3.4) and lowest in 2020 (2.1) and significantly decreased over the study period. Male children and Black and Hispanic/Latino children had the highest incidence of ocular trauma. A significant seasonal pattern was observed, with the highest incidence in May and the lowest in January (P<0.01). Geographically, the highest incidences were in the Inland North and Central Valley regions. Over the 6-year period, the percentage of self-pay (uninsured) pediatric patients decreased over time, and public insurance (Medicaid/Title V) remained the most common payor.

Conclusion: Ocular trauma represents a small fraction of ED visits for children in California. The incidence of ocular trauma ED visits decreased over the study period and displayed a seasonal trend. Higher incidence of ocular trauma were observed in male and Black and Hispanic/Latino children.

Keywords: emergency department; epidemiology; health disparities; pediatric ocular trauma; pediatric ophthalmology; seasonal trends.

Figure 1

Ocular trauma-related ED visits between 2012 and 2021. (A) Number of all ED visits and ocular trauma ED visits by year for adults >18 years; (B) number of all ED visits and ocular trauma ED visits by year for children ≤18 years; (C) normalized ratio of ocular trauma ED visits to total ED visits by year; (D) number of visits by age.

Figure 2

Yearly incidence (ED visits per 1000 individuals) in ocular trauma-related ED visits. (A) Adults >18 years and children ≤18 years; (B) children stratified by gender; (C) children stratified by self-reported race/ethnicity; (D) children stratified by primary language; (E) children stratified by type of ocular trauma.

Figure 3

Monthly trends in ocular trauma-related ED visits among children ≤18 years. (A) Incidence of ocular trauma ED visits by month per 10,000 children; (B) seasonality of ocular trauma ED visits; (C) monthly incidence of ocular trauma ED visits per 10,000 children by sex; (D) monthly incidence of ocular trauma ED visits per 10,000 children by age.

Figure 4

Ocular trauma-related ED visits by geographic regions. (A) California county categorization into four geographic regions; (B) monthly ocular trauma incidence across regions per 10,000 children.

Figure 5

Payor mix over time. (A) Percentage of visits by insurance status; (B) percentage of visits by payor category. Patients with payer category “Self-pay/Uninsured” were designated as insurance status uninsured. Patients with all other payer categories were designated as insurance status insured.