Vision Survival after Open Globe Injury Predicted by Classification and Regression Tree Analysis

Schmidt, Gregory W.; Broman, AT; Hindman, Holly B.; Grant, Michael P.

doi:10.1016/j.ophtha.2007.04.008

Cited by 201 publications

(186 citation statements)

References 45 publications

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“…In the CART model, the absence of an RAPD led to 96.9% chance of visual survival and 3.1% of no vision. 18 In concurrence with the Initial visual acuity was also a strong predictor of visual outcome in our study (Po0.0001). In our series, an initial visual acuity of NPL was associated with poor visual outcome, accounting for 60.9% of the no-vision group and only 1.3% of the vision survival group.…”

Section: Discussionsupporting

confidence: 76%

“…18 In this model, the absence of an RAPD was the best predictor of visual survival. If there was an RAPD, the next variable was the initial visual acuity.…”

Section: The Cartmentioning

confidence: 91%

“…18 They analysed 214 patients with open globe injuries at the Wilmer Ophthalmological Institute and constructed a classification tree using binary recursive partitioning. In the classification tree, the presence of an RAPD and poor initial visual acuity were the most predictive of visual loss; the presence of lid laceration and posterior wound location also predicted poor visual outcome.…”

Section: Introductionmentioning

confidence: 99%

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Visual outcome after open globe injury: a comparison of two prognostic models—the Ocular Trauma Score and the Classification and Regression Tree

Yu‐Wai‐Man

Steel

2009

Eye

120

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Aims To compare the ocular trauma score (OTS) and the classification and regression tree (CART) as prognostic models of visual outcome after open globe injury. Methods A retrospective review of 100 consecutive open globe injuries at the Sunderland Eye Infirmary was conducted from January 1999 to December 2007. Univariate chi-square analysis was used to identify the variables associated with visual outcome. We compared the CART and OTS predictions with the actual visual outcomes and calculated the sensitivity and specificity of each model. Results The variables most predictive of visual loss were an RAPD, poor initial vision, lid laceration, posterior wound, and globe rupture. The sensitivity to predict visual survival (LP or better) was 97.4% for OTS and 93.5% for CART. The specificity to predict no vision (NPL or enucleation) was 100% for OTS and 73.9% for CART. The sensitivity to predict minimal-to-severe visual loss (3/60 or better) was 90.9% for OTS and 85.7% for CART. The specificity to predict profound visual loss (worse than 3/60) was 100% for OTS and 81.8% for CART. Conclusions We identified several factors that can help in deciding on the prognostic value of primary globe repair. Both the OTS and CART had high predictive accuracy, but the OTS had higher prognostic accuracy and could be used in counselling patients and in management decision-making.

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Section: Discussionsupporting

confidence: 76%

“…18 In this model, the absence of an RAPD was the best predictor of visual survival. If there was an RAPD, the next variable was the initial visual acuity.…”

Section: The Cartmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Visual outcome after open globe injury: a comparison of two prognostic models—the Ocular Trauma Score and the Classification and Regression Tree

Yu‐Wai‐Man

Steel

2009

Eye

120

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“…Severity of open-globe injuries was assessed using classification and regression tree (CART) analysis. 6 Our statistical analysis is descriptive, with average values given as the median in those cases in which the data is not numeric or does not appear to follow the normal distribution, and as the mean in other cases. We used Spearman's rank to calculate the correlation of final VA with OTS.…”

Section: Methodsmentioning

confidence: 99%

Ophthalmic injuries in British Armed Forces in Iraq and Afghanistan

Blanch

Bindra

Jacks

et al. 2010

Eye

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Outcomes assessed by final best-corrected visual acuity (VA; few patients lost to follow-up), rates of endophthalmitis, and proliferative vitreoretinopathy (PVR). Results There were 630 cases of major trauma, 63 sustained eye injuries (10%), and 48 sustained significant eye injuries. There were 21 open-globe injuries: 9 ruptures and perforating injuries, of which 7 were enucleated/eviscerated; 11 intraocular foreign body (IOFB) injuries, of which 1 was eviscerated. Primary repair was combined with posterior segment reconstruction in 9/11 cases with IOFB. Mean time to primary repair was 1.9 days (range 0-5). Intravitreal antibiotics were given at primary repair in five cases. All cases received early broad-spectrum systemic antibiotics. Median final VA was logMAR 0.25 excluding evisceration/enucleations. There were two cases of PVR and none of endophthalmitis. Conclusions The number of eye injuries as a proportion of all casualties is lower than recently reported. The injuries are more severe than in civilian practise. The outcomes were comparable with previous reports, this demonstrates that, in certain cases, primary repair can be safely delayed beyond 24 h in the patient's best interests, in order to optimise the conditions for treatment.

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“…The magnetic flux may cause them to move within the eye and cause further intraocular damage. 12 Ocular trauma scoring systems such as the Ocular Trauma Score 13 and the classification and regression tree (CART) 14 have been developed to predict visual outcome and prioritise ocular management within a multisystem trauma patient. These scoring systems include features often identifiable from CT scanning such as the presence of globe rupture, perforating injury, retinal detachment and the presence of an intraocular foreign body.…”

Section: Introductionmentioning

confidence: 99%

The role of computerised tomography in predicting visual outcome in ocular trauma patients

Chaudhary

Upendran

Campion

et al. 2015

Eye

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Purpose Ocular blast injuries in the military setting are particularly associated with significant maxillofacial trauma and/or brain injury. The opportunity to perform a comprehensive ophthalmic evaluation is frequently limited in the acute multiple trauma scenario. We aim to describe the relationship between the clinical effects of acute ocular and orbital blast trauma with the findings on computerised tomography (CT). Methods This was a retrospective consecutive case series of all soldiers with facial and/or suspected ocular injuries. A total of 80 eyes that had suffered blast injuries of varying severity were studied. Assessment of orbital and ocular CT images were performed by military consultant radiologists. A comparison was made with actual clinical findings. Statistical analysis was performed using Fisher's exact test.Results No pathological findings were described in 37 of the 80 eyes imaged by orbital and ocular CT scans. Clinically, these eyes and orbits were all found to be intact, or had minor trauma. All foreign bodies and penetrating eye injuries were successfully diagnosed by CT. Absence of an orbital fracture did not rule out a globe injury. However, a corneal or scleral defect was less likely when an orbital fracture was absent. Conclusion The eye is a delicate structure prone to injury that requires urgent repair if breached. It is difficult to assess thoroughly in the unconscious or distressed patient. In this context, CT imaging is invaluable to be able to make a relatively confident prediction of clinical findings and decide upon the necessity for acute ophthalmic surgical intervention.

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Vision Survival after Open Globe Injury Predicted by Classification and Regression Tree Analysis

Cited by 201 publications

References 45 publications

Visual outcome after open globe injury: a comparison of two prognostic models—the Ocular Trauma Score and the Classification and Regression Tree

Visual outcome after open globe injury: a comparison of two prognostic models—the Ocular Trauma Score and the Classification and Regression Tree

Ophthalmic injuries in British Armed Forces in Iraq and Afghanistan

The role of computerised tomography in predicting visual outcome in ocular trauma patients

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