Presentations and Management of Pediatric Orbital Floor Fractures: A National Trauma Database Study

Introduction: Orbital floor fractures are a common facial fracture in pediatric populations; however, there is a paucity of literature characterizing these injuries. In this study, we aim to understand the presentation and management of orbital floor fractures in children at pediatric and non-pediatric trauma centers.

Methods: This is a retrospective, cross-sectional analysis of the National Trauma Data Standard (2017-2022) published by the American College of Surgeons. All pediatric ( < 18 years old) encounters with an ICD-10 code for orbital floor fracture were included. Demographics, injury characteristics and trauma center classification were used to characterize the presentation of pediatric orbital floor fractures and compare management outcomes based on the type of trauma center.

Results: A total of 7309 pediatric orbital floor fractures were identified, with 70.8% seen at pediatric trauma centers and 29.1% seen at non-pediatric trauma centers. A majority of patients were male (68.2%) and white (53.3%), with an average age of 11.7 years old. Most fractures were caused by unintentional trauma (88.3%), which was mostly blunt trauma (95.3%), although 237 children (3.2%) had injuries caused by firearms. Only 15.5% required surgical repair of the fracture, and after adjusting for multiple factors, patients were found to have 18% greater odds of undergoing surgical repair if they were seen at a pediatric trauma center (95% CI: 1.02, 1.37).

Conclusions: A substantial number of children with orbital floor fractures are evaluated at trauma centers that are not specialized in pediatric care. Our findings show that children are more likely to undergo surgery during their initial presentation at a pediatric trauma center indicating the importance of these specialized hospitals and a factor that may impact patient outcomes.