A New Tool to Characterise the Relative Severity of Eye Injuries: The Synthetic Score of Relative Dangerousness (SSRD)

Sanjoy Chowdhury¹*, Sneha Kumari² and Priyanka²

¹ Joint Director Medical and Health Services, SAIL/BGH, Bokaro Steel City, Jharkhand
² Bokaro General Hospital, Jharkhand

*Corresponding Author: Sanjoy Chowdhury, Joint Director Medical and Health Services, SAIL/BGH, Bokaro Steel City, Jharkhand.

Received: June 18, 2017; Published: July 12, 2017

Citation: Sanjoy Chowdhury.,et al. “A New Tool to Characterise the Relative Severity of Eye Injuries: The Synthetic Score of Relative Dangerousness (SSRD)”. Acta Scientific Medical Sciences 1.2 (2017).

Abstract

Background: The epidemiological data regarding eye injuries are very scarce in India. Most are hospital based which show only the clinical patterns and visual outcome lacking vital epidemiological clues. Prevention being the best way for tackling any injury the analysis of dangerousness of the offending object could be an important step.

Aim: To study the dangerousness of offending object by developing a decision-making tool the Synthetic Score of Relative Dangerousness (SSRD).

Methods: This is part of ongoing prospective study on eye injuries occurring in a steel township. SSRD is calculated for 50 consecutive eye injuries attending eye OPD during 2012 - 2013. It is calculated empirically using 4.

Variables:The number of injuries in which the product was involved (NB), the hospitalisation rate (HR) and the mean duration of the hospitalisation (MDH), ratio of initial and final visual acuity. A score ranging from 1 to 20 is assigned to each of these variables according to which percentile the product is classified as belonging to (classified by increments of 5). Sum of four variables gives SSRD value. Higher the score more is the severity.

Results:In our study, tennis ball, unexploded cracker, assault and road traffic accident had the highest SSRD (63).

Conclusion: The results obtained contribute to establishing priority actions at the community level. The SSRD can be calculated every year and this will make it possible to track the dangerousness of an object over time and adopt preventive measures. The methodological weaknesses of this score are linked to the way the information is gathered (specific features of the hospital collecting data), its quality and exhaustiveness. The advantages of this score are the fact that it is easy to calculate and perform and that it can be used over time and at national level. The results obtained match the ‘impressions of seriousness’ about which there is a consensus in the field of home and leisure injuries.

Keywords: Epidemiological Clues; Eye Injuries; Ocular Trauma

Introduction

  Ocular trauma is one of the commonest causes of mono ocular visual loss, 90% of which are preventable. Though human eye covers 0.1% body area it sustains 10% of all injuries. The American Medical Association’s guides to the evaluation of permanent impairment rate permanent impairment to the visual system is commonly rated on an almost equal rate of impairment as to the “whole man” (“a total loss of vision in one eye equals a 25% Impairment of Visual System and a 24% Impairment of Whole Man”).

  From a public health point of view, it is the epidemiology of injury, not of accidents that is most important. The scientific interest of all these disorders is their potential for producing permanent anatomical or functional complications (e.g., disfigurement, visual impairment).

   The epidemiological data regarding eye injuries are very scarce in India. Most of the data are taken from the hospital records which show only the clinical patterns and visual outcome lacking vital epidemiological clues [1]. Prevention being the best way for tackling any injury, the analysis of dangerousness of the offending object could be an important step.

   According to Gibson [2] an injury is damage to a person or to a tissue/organ, e.g., the eye, caused by a transfer of energy, namely one of the five forms of physical energy: mechanical, thermal, chemical, electrical and radiant. Consequently, eye injuries include all damage caused to the eye and its adnexa, orbital and periorbital tissues due to direct contact with fixed or mobile, blunt or sharp objects (mechanical energy being transferred for example by rapid deceleration), hot objects (thermal), chemical substances, sources of electrical power, different types of radiation (UV, X-ray, microwave).

  There are different types of assessment systems/scores for Eye Injury, like The United States Eye Injury Registry (USEIR) developed the Ocular Trauma Score (OTS) with support from the Centers for Disease Control and Prevention (CDC). The OTS provides a single probability estimate of an eye trauma patient to obtain a specific visual range by six months after injury [3].

  Lack of scoring for prevention applicable to community level has urged to do this study. Primary aim is to study the dangerousness of offending object by developing a decision-making tool the Synthetic Score of Relative Dangerousness (SSRD) [4].

Methods

  This is part of ongoing prospective study on eye injuries occurring in a steel township in India. SSRD is calculated for 50 consecutive cases of eye injuries attending our Hospital during 2012 - 2013. It is calculated empirically using 4 variables: the number of injuries in which the product was involved (NB), the hospitalisation rate (HR) and the mean duration of the hospitalisation (MDH), ratio of initial and final visual acuity (Figure 1). A score ranging from 1 to 20 is assigned to each of these variables according to which percentile the product is classified as belonging to (classified by increments of 5). Thus, a higher score is assigned to an object that is more frequently involved in injuries (and which is therefore more dangerous).

Figure 1: Four variables used to calculate SSRD: Number of involvements as agent.

Results

  50 consecutive cases attending Bokaro general hospital for eye trauma were registered for this study

  Strong male bias was seen. Only 5 female cases were registered (Assault, domestic injury) Age ranged from 3 months (corneal injury in babies while using Kajal,blouse hook trauma while breast feeding, (Figure 2) to 74 years (fall). Results are shown in (Figure 3) Score was lowest with ocular foreign bodies and highest with assault and road traffic accidents. Fireworks (Figure 4) and sports injuries (Figure5) scores were also alarming.

Figure 2: Domestic injury from blouse hook in infant SSRD 12.

Figure 3: Table Showing SSRD Scores in Different Groups of Cohorts.

Figure 4: SSRD in Fireworks Injuries May Range from Minimum to Maximum. Yearly Calculations are Helpful in Policy Making Policy Decisions.

Figure 5: Sports Related Injury May Score Very High which will need Protective Eye Gear for Prevention.

Discussion

  Severity score was highest with assault (Figure 6) and least with corneal foreign body. No case of intraocular foreign body was registered. This study shows that injury scoring can be done to determine the severity of offending object (Figure 7). The other scoring system, OTS is meant to be a continually evolving scoring system to be used by the clinician to facilitate patient counselling, treatment, rehabilitation, and research (Figure 8).

Figure 6: Maximum SSRD score registered among acid burn (assault) cases, banning of open sale of acid is gradually reducing the score: excellent application of SSRD scoring system.

Figure 7: SSRD Score 63 in Blast Injury: Though Visual Outcome is Good but other variable Contributed Significantly.

Figure 8: Minimum SSRD score noticed in ocular Foreign Bodies. Prevention Strategy: Mandatory use of Proper Protective Gear.

  The results obtained contribute to establishing priority actions at the community level. Seasonal intervention for fireworks (Figure 9) and warning roadside billboards were useful in reducing SSRD. The methodological weaknesses of this score are linked to the way the information is gathered (specific features of the hospital collecting data), its quality and exhaustiveness. The advantages of this score are the fact that it is easy to calculate and perform and that it can be used over time and at national level [5]. The results obtained match the ‘impressions of seriousness’ about which there is a consensus in the field of home and leisure injuries.

Figure 9: High SSRD Score in Road Traffic Accident mostly due Bad Road Conditions: Cautionary Billboard at Bad Patches Effectively Reduces Score.

Bibliography

1. Khatry SK., et al. “The epidemiology of ocular trauma in rural Nepal”. British Journal of Ophthalmology 88.4 (2004): 456-460.
2. Gibson JJ. “The contribution of experimental psychology to the formulation of safety: a brief basic research”. In: Behavioral approaches to accident research. New York, Association for the Aid of Crippled Children, (1961).
3. www.asotonline.org/ots.html. Accessed on Sept 2006
4. Nectoux M and Darlot JP. “Tool to Characterise The Relative Severity of Home and Leisure Injuries: The Synthetic Score of Relative Dangerousness”. Poster presented at “Safety2006”.
5. AD Negrel. “Magnitude of Eye Injuries Worldwide”. Community Eye Health Journal 10.24 (1997): 49-53.

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Copyright: © 2017 Sanjoy Chowdhury.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.