A review of globe injuries in children hospitalized at Kenyatta National Hospital

Abstract

The study was aimed at describing the epidemiology, the injuries, the interventions and the post treatment complications. It sought to estimate the cost of care and to identify factors that may influence the outcome of ocular trauma. Retrospective case series. The study was conducted at Kenyatta National hospital (KNH), which is the national and referral hospital in Nairobi, Kenya. All children up to 15 years of age who were admitted with globe injuries at KNH from January 1, 2000 to December 31,2004. Medical records of the subjects were retrieved from the hospital registry and analyzed. The data was collected using a structured questionnaire . Subsequently, it was entered into the computer and analyzed using the Statistical Package for Social Scientists (SPSS). In this series of 182 children, 95 (52.2%) of the children came from outside Nairobi city while 87(47.8%) came from within the city. All the children had uniocular trauma and the age group that was most frequently affected was 4-9 years, forming 55% of the series. The male: female ratio was 2.4: 1 with the boys forming 71% while the girls formed 29% of the patients. 91% of the injuries occurred during play. The stick was the most common cause of trauma in 74(40.7%) of the children. Open- globe injuries occurred in 70% while closed- globe injuries occurred in 30% of the children. Most of the children (77.9%) presented at the first health facility within l day after injury but only 21(1l.7%) and 20(1l.2%) of the children received tetanus prophylaxis and ocular protection with a pad respectively before referral to KNH. On admission at KNH, 47.8% of the children were blind, 5.5% were severely visually impaired, 3.8% were visually impaired, 7.6% had normal vision, in 17.6% visual acuity was recorded as 'fixates' and in 17.6% visual acuity was not recorded. It was observed that 66.7% of those who required emergency surgery were operated within 24 hours of admission. Amblyopia therapy was done in only 15(18%) of the children. Corneal opacity was the most common post treatment complication. Endophthalmitis occurred in 3 (1.6%) cases. A general trend of improvement of visual acuity was observed between admission to hospital and the follow-up visit at 6 weeks. There was a statistically significant association between the visual acuity at hospitalization and at 2-weeks follow-up (P value 0.001). The mean duration of hospitalisation was 10 days with a mean bill of KSh. 6,233 ($ 87).

Most of the victims of trauma were boys aged 4-9 years. Most of the children sustained open globe injuries caused by sticks. Most children presented to the first health facility on the day they were injured but the treatment offered was considered to be inadequate. There was delayed presentation of the children at KNH upon referral possibly due to financial constraint and long distances but 2/3 were operated on within 24 hours of admission. It is probable that the surgeons abscised iris far often than was necessary and that amblyopia therapy was done in fewer cases than was needed. It was also thought that the repeat operations within 1 week of the initial procedure in 8 children could have been avoided if more caution was exercised. It appears that the mean duration of in-hospital stay at KNH has not reduced in the last decade despite advances in technology, as one would expect to be the case. The visual acuity at admission to hospital was considered to be of prognostic significance.

Public health education concerning prevention of eye injuries; equipping of peripheral health facilities; availing the eye theatre at KNH on a daily basis; incorporation of clinical audits in training of personnel and hospital-decision making were regarded as possible means of reducing the incidence of trauma to the globe and its impact in children.