Ocular Injury in United States Emergency Departments: Seasonality and Annual Trends Estimated from a Nationally Representative Dataset

Purpose: To determine whether ocular trauma occurs more frequently in the summer months. Design: Retrospective, cross-sectional study. Methods: The Nationwide Emergency Department Sample (NEDS) is a large, publicly available administrative database that provides nationally representative estimates of emergency department (ED) visits in the United States. Billing codes from NEDS from 2006 to 2013 were used to identify all cases of ocular trauma, and the United States decennial census was used to estimate the population at risk for visiting an ED. The main outcome measures were the seasonal and annual trends in the incidence of ED-diagnosed eye trauma. Results: Eye trauma was the primary diagnosis for an estimated 5 615 532 ED encounters over the 8-year study period. Those with an eye trauma encounter were predominantly male (66%) and under 60 years of age (91%). The most common ocular trauma presentations were superficial injury of eye and adnexa (101 ED-diagnosed cases per 100 000 population), extraocular foreign body (54 per 100 000 population), contusion of eye and adnexa (27 per 100 000 population), and ocular adnexal open wound (26 per 100 000 population). Each exhibited a statistically significant annual cycle, with a mean annual peak between May and July (P <.01 for each, Edwards test). Eye trauma visits decreased by an average of 4% per year over the study period, with a similar pattern of decline during each calendar month (incidence rate ratio 0.96, 95% confidence interval 0.94–0.98). Conclusions: Eye trauma, although decreasing in incidence, is a seasonal condition. Prevention efforts would likely be most effective if implemented in the spring or summer months. Further study to identify other individual-level or regional-level factors that would most benefit from public health efforts is warranted.