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

Abstract

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.

Ophthalmic injuries in British Armed Forces in Iraq and Afghanistan

“…Our outcomes are broadly in line with those originally reported by Kuhn Man and Steel, 7 with a non-significant difference in favour of CART.…”

“…Sensitivity and specificity for OTS and CART were calculated for open-globe injuries as previously described. 7 McNemar w 2 -test was used to compare sensitivity and specificity measures of CART and OTS, as previously described. 8 P-values were 40.05 for all comparisons.…”

Ocular Trauma Score as a predictor of final visual outcomes in traumatic cataract cases in pediatric patients

“…Using the OTS, 98.9% of eyes in the general population could be graded in a trauma room. Knyazer et al 35 report the prognostic value of the OTS in zone-3 open-globe injuries, and Man et al 36 found that the OTS and the CART had equal prognostic effectiveness in the general population.…”

Epidemiological characteristics and visual outcome after open globe injuries in children

“…17,19,23 This would be expected clinically as posterior segment injury can cause irreversible damage to the retina and optic nerve and thus carry a poor visual prognosis, even after the structural integrity of the globe has been repaired. 18 Children may develop more extensive postoperative inflammation, scarring, and proliferative retinopathy than adults, and these may affect anatomical and functional outcomes. 28,29 Retinal detachment develops in approximately 40% to 50% of eyes with posterior open globe injuries and is associated with a particularly poor prognosis.…”