IMPORTANCE Determining the epidemiology of eye-related emergency department (ED) visits on a national level can assist policymakers in appropriate allocation of resources. OBJECTIVE To study ED visits related to ocular conditions for all age groups across the United States. DESIGN, SETTING, AND PARTICIPANTS Nationally representative data from the US Nationwide Emergency Department Sample (NEDS) were used to analyze ED visits from January 1, 2006, to December 31, 2011 (6 years). All patients with eye problems presenting to EDs across the United States were eligible for inclusion. A weighted count of 11 929 955 ED visits were categorized as possibly emergent (emergent), unlikely to be emergent (nonemergent), or could not be determined. Data were analyzed from March 1 to May 30, 2015. MAIN OUTCOMES AND MEASURES Population-based incidence rates of eye-related ED visits, incidence rates of eye injuries, relative proportions of emergent vs nonemergent eye-related ED visits among different age groups, and independent factors associated with emergent vs nonemergent visits. RESULTS From 2006 to 2011, 11 929 955 ED visits (male patients, 54.2%; mean [SD] age, 31 [22] years) for ocular problems across the United States were categorized as emergent (41.2%), nonemergent (44.3%), or could not determine (14.5%). Corneal abrasions (13.7%) and foreign body in the external eye (7.5%) were the leading diagnoses in the emergent category. More than 4 million visits were for conjunctivitis (28.0%), subconjunctival hemorrhages (3.0%), and styes (3.8%). Emergent visits were significantly more likely to occur among males (odds ratio [OR], 2.00; 95% CI, 2.00-2.01), patients in the highest income quartile (OR, 1.47; 95% CI, 1.46-1.49), older patients (OR, 2.38; 95% CI, 2.38-2.44), and patients with private insurance (OR, 1.29; 95% CI, 1.28-1.30). Mean annual inflation-adjusted charges for all eye-related ED visits totaled $2.0 billion. CONCLUSIONS AND RELEVANCE Across the United States, nonemergent conditions accounted for almost half of all eye-related ED visits. Interventions to facilitate management of these cases outside the ED could make ED resources more available for truly emergent ophthalmic and medical issues.

IMPORTANCE Determining the national epidemiologic trends of chemical ocular burns can assist physicians and policy makers in appropriate allocation of resources for treatment and prevention. OBJECTIVE To describe the epidemiologic trends and risk factors for chemical burns of the eye.

IMPORTANCE Ocular trauma can lead to lifelong sequelae, and sports-related ocular injuries have been shown to disproportionately affect the young. Studies quantifying and characterizing the incidence and type of injuries seen with sports-related ocular trauma may be useful for resource utilization, training, and prevention efforts.OBJECTIVE To examine the emergency department (ED) burden of sports-related ocular trauma in the United States.DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study examined the Nationwide Emergency Department Sample, containing data from approximately 30 million ED visits annually at more than 900 hospitals nationwide, from January 1, 2010, to December 31, 2013, to determine factors associated with sports-related ocular trauma. MAIN OUTCOMES AND MEASURESAnnual incidence of sports-related ocular trauma, broken down by age, sex, mechanism of injury, and related activity, as well as factors associated with short-term impaired vision.RESULTS During the study period, 120 847 individuals (mean age, 22.3 years [95% CI, 21.9-22.7]; 96 872 males, 23 963 females, and 12 with missing data) presented with sports-related ocular trauma, which was the primary diagnosis in 85 961 patients. Injuries occurred most commonly among males (69 849 [81.3%]; 95% CI, 80.6%-81.9%) and occurred most frequently as a result of playing basketball (22.6%; 95% CI, 21.7%-23.6%), playing baseball or softball (14.3%; 95% CI, 13.7%-14.9%), and shooting an air gun (11.8%; 95% CI, 10.8%-12.8%). Odds of presentation to the ED with impaired vision were greatest for paintball and air gun injuries relative to football-related injuries (odds ratio, 4.75; 95% CI, 2.21-10.19 and 3.71; 95% CI, 2.34-5.88, respectively; P < .001). CONCLUSIONS AND RELEVANCEIn our study, approximately 30 000 individuals presented annually to EDs in the United States with sports-related eye injuries; in more than 70% of these cases, eye injuries were the primary diagnosis. Activities involving projectiles pose the greatest risk for visual impairment in the short term, although long-term outcomes were unavailable.

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Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background The negative effects of bullying, discrimination, harassment, and sexual harassment (BDHS) on wellbeing and productivity of surgical residents in training have been well documented. Despite this, little has changed over the past decade and these behaviors continue. The purpose of this study was to determine the prevalence of each abusive behavior experienced by residents, identify the perpetrators, and examine the reporting tendency. Methods A systematic review of articles published between 2010 and 2020 in the MEDLINE, EMBASE, and Cochrane databases was performed following PRISMA guidelines. The following search terms were used: bullying, harassment, sexual harassment, discrimination, abuse, residency, surgery, orthopedic surgery, general surgery, otolaryngology, obstetrics, gynecology, urology, plastic surgery, and training. Results Twenty-five studies with 29,980 surgical residents were included. Sixty-three percent, 43, 29, and 27% of surgical residents experienced BDHS, respectively. Female residents reported experiencing all BDHS behaviors more often. Thirty-seven percent of resident respondents reported burnout, and 33% reported anxiety/depression. Attending surgeons, followed by senior co-residents, were the most common perpetrators. Seventy-one percent did not report the behavior to their institution. Fifty-one percent stated this was due to fear of retaliation. Of those who reported their experiences, 56% stated they had a negative experience reporting. Conclusion Our review demonstrates high prevalence rates of BDHS experienced by residents during surgical training, which have been associated with burnout, anxiety, and depression. The majority of residents did not report BDHS due to fear of retaliation. Residency programs need to devise methods to have a platform for residents to safely voice their complaints.

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There is an urgent need to better understand the natural history of head trauma in the >800,000 pediatric patients presenting each year for outpatient care. These outpatient injuries, which are more than double the number of head trauma cases recorded in the hospital-affiliated settings, illustrate the potential importance of expanding inclusion criteria in surveillance and prevention efforts designed to address this critical issue.