@article {1549031,
	title = {Factors Associated With Increased Risk of Serious Ocular Injury in the Setting of Orbital Fracture},
	journal = {JAMA Ophthalmol},
	volume = {139},
	number = {1},
	year = {2021},
	month = {2021 Jan 01},
	pages = {77-83},
	abstract = {Importance: Orbital fractures are common in ocular trauma, and there is a need to develop predictive tools to estimate risk of concurrent ocular injury. Objective: To identify clinical and radiographic features that are associated with increased risk of substantial ocular injury in the setting of orbital fracture. Design, Setting, and Participants: Retrospective consecutive case series of patients who sustained orbital fractures between 2012 and 2018. Examinations were done at 1 of 2 level 1 trauma centers in the emergency or inpatient setting. A total of 430 consecutive patients (500 eyes) between 2012 and 2017 met inclusion criteria for the training sample. After building a predictive model, 88 additional consecutive patients (97 eyes) between 2017 and 2018 who met inclusion criteria were collected as a test sample. Main Outcomes and Measures: The primary outcome measure was substantial ocular injury distinct from orbital fracture. Results: The mean age of our patient population was 53.5 years (range, 16-100 years). The overall rate of substantial ocular injury was 20.4\%, and the rate of injury requiring immediate ophthalmic attention was 14.4\%. Five variables were found to be associated with increased risk of substantial ocular injury: blunt trauma with a foreign object (odds ratio [OR], 19.4; 95\% CI, 6.3-64.1; P \&lt; .001), inability to count fingers (OR, 10.1; 95\% CI, 2.8-41.1; P = .002), roof fracture (OR, 9.1; 95\% CI, 2.8-30.0; P = .002), diplopia on primary gaze (OR, 6.7; 95\% CI, 1.7-25.1; P = .003), and conjunctival hemorrhage or chemosis (OR, 4.2; 95\% CI, 2.2-8.5; P \&lt; .001). The results were translated into a bedside tool that was tested in an independent group of eyes (n = 97) and found to be associated with substantial ocular injury with a 95\% sensitivity (95\% CI, 77.2-99.9), 40\% specificity (95\% CI, 28.9-52.0), 31.8\% positive predictive value (95\% CI, 27.5-36.5), and 96.8\% negative predictive value (95\% CI, 81.3-99.5). Conclusions and Relevance: A minority of patients with an orbital fracture had a substantial ocular injury. Certain radiographic and clinical findings were associated with substantial ocular injury. Testing of the algorithm in prospective longitudinal settings appears warranted.},
	issn = {2168-6173},
	doi = {10.1001/jamaophthalmol.2020.5108},
	author = {Rossin, Elizabeth J and Szypko, Colleen and Giese, Isaiah and Hall, Nathan and Gardiner, Matthew F and Lorch, Alice}
}
