171. Predictors of Globe Injuries in Over 340,000 Facial Fracture Patients: A National Trauma Data Bank Study

PURPOSE: Globe injuries (GI) are a serious complication of facial trauma that can lead to permanent vision loss and significant long-term disability. GI can be challenging to identify in the setting of facial trauma due to concurrent injuries and facial swelling. Thus, determining the predictors of GI in the setting of facial fractures would improve early identification and treatment. This study utilizes the National Trauma Data Bank (NTDB) to identify risk factors for globe injuries among patients with facial fractures, to improve timely ophthalmologic consultation and intervention. METHODS: The NTDB was queried from 2017-2019 for adult patients who sustained facial fractures. The study cohort included the following fracture types: cranial, orbital, zygomatic, maxillary, naso-orbito-ethmoid (NOE) complex, nasal, and mandibular. Concomitant GI were identified through ICD-10-CM codes. Independent variables included patient demographics, injury mechanisms, injury location and protective device usage, including eye protection. RESULTS: A total of 340,827 patients with facial fractures were included in the analysis. Of those patients, 15,371 (4.5%) sustained concomitant GI. These were found most often in patients with combined cranial and orbital fractures (12.4%) and those with combined orbital and nasal fractures (11.8%). Among patients with isolated fractures, orbital fractures had the highest rate of GI (11.6%) followed by zygomatic fractures (8.3%), and maxillary fractures (7.3%). Corneal epithelial defects were the most common type of GI, followed by conjunctival lacerations and traumatic optic neuropathy. Following a multivariable logistic regression, there were several significant variables showing association with GI. Notably, the use of eye protection was paradoxically associated with an increased risk of globe injury (OR 4.17, 95% CI 2.90-6.00). Other significant predictors of globe injury included orbital fractures (OR 3.52, 95% CI 3.39-3.66), assaults (OR 1.78, 95% CI 1.69-1.87), penetrating trauma (OR 1.73, 95% CI 1.54-1.94), and farm-related injuries (OR 1.71, 95% CI 1.42-2.07). Mandibular fractures (OR 0.60, 95% CI 0.57-0.63) and injuries occurring at schools (OR 0.60, 95% CI 0.57-0.63) were negatively associated with risk of globe injury. CONCLUSIONS: This study identified key predictors of globe injuries in patients with facial fractures which include combined cranial-orbital fractures, high-energy injuries, and rural/farm environments. The unexpected association between eye protection and globe injuries is likely due to reporting bias but could be related to working higher risk occupations. Further investigation is needed to understand the role of protective devices in preventing ocular trauma. These findings emphasize the importance of early ophthalmologic consultation for high-risk patients, particularly those with periorbital trauma or high-energy injuries. Understanding these risk factors can improve patient outcomes by facilitating early diagnosis and intervention.