R. S. Haring1,2,3,4, I. D. Sheffield5, J. K. Canner3, A. H. Haider1,2, E. B. Schneider1,2,3,4 1Harvard School Of Medicine,Brookline, MA, USA 2Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 3Johns Hopkins University School Of Medicine,Johns Hopkins Surgery Center For Outcomes Research,Baltimore, MD, USA 4Johns Hopkins Bloomberg School Of Public Health,Dept. Of Health Systems And Policy,Baltimore, MD, USA 5Brigham Young University,Provo, UT, USA
Introduction: Ocular chemical burns are a severe form of injury, often leading to long-term morbidity, including reduced visual acuity and quality of life. A review of the current literature on ocular burns found that chemical burns are most common among working-age men, suggesting that these types of injuries can have a substantial impact on quality-adjusted life years. Alkaline burns, which penetrate deeper and faster into the cornea, are the most severe form of chemical burn, and are associated with significantly poorer outcomes than acid burns. Currently, there are no large-scale epidemiologic studies that describe the incidence and burden of alkaline ocular burns in the United States. We sought identify and characterize trends, incidence, and characteristics related to patients presenting to Emergency Departments (EDs) in the US from 2006-2012 with alkaline ocular burns.
Methods: Using the Nationwide Emergency Department Sample (NEDS), we identified all patients who presented with an ICD-9-CM diagnosis of alkaline ocular burn from 2006-2012. We examined burden and trends related to age and sex to determine which populations were at highest risk of alkaline ocular burn injury. Age-specific population-based rates were calculated using the US Census Bureau’s intercensal and postcensal estimates. Chi square tests were used to compare subsets across time and between age and sex groupings.
Results: Patient age at ED presentation for treatment of alkaline ocular burns followed a bimodal distribution, with the highest population-based injury rates occurring among 1-year old infants (1.29 per 100,000), with a lower rate among two-year-olds (0.811 per 100,000). The second-highest injury-rates were found among adults in their twenties (e.g., 1.28 per 100,000 among 28-year olds). Overall, 55.2% of alkaline burn injuries occur among 20-45 year olds, and among this group, 67.9% of patients were male. Mean patient age at presentation was 35.5 years (95% CI: 34.7-36.3), and did not vary by sex (p=0.991).
Conclusion: Alkaline ocular burns are among the most critical and severe forms of ocular injury. Earlier studies and reviews in the literature identified working-age men as a high-risk cohort; however, we discovered that the single highest-risk age-based rate of ED presentation with alkaline ocular burns is found among one-year-old children. These findings may be used to aid in the design and implementation of appropriate prevention efforts, which may range from appropriate storage of chemicals in the home to policies on protective eyewear in the workplace. Special attention must be paid to preventing access to alkaline agents among the youngest of children and educating parents on the need for rapid appropriate response when alkaline ocular burn is suspected in an infant.