Abstract
Introduction
Open globe injuries require urgent surgical repair. Whether trauma center verification level influences the care pathway has not been characterized using national data.
Methods
Multinomial logistic regression evaluated care pathways among 2,282 eligible direct arrivals at Level I -III centers, adjusting for demographics, injury severity, and clinical factors. Secondary analyses evaluated globe closure and arrival-to-closure timing. The main outcome measures included on-site definitive surgery (closure or enucleation), transfer without documented on-site definitive surgery, or neither.
Results
Compared with Level I, Level II and III centers had higher adjusted relative risk ratios for transfer versus on-site surgery: 12.96 (95% CI, 9.74 -17.25) and 71.17 (40.81 -124.13), respectively. Adjusted probabilities of on-site surgery were 63.8%, 30.7%, and 10.7% at Levels I, II, and III. Globe-closure odds were lower at Level II (adjusted OR, 0.227; 95% CI, 0.179 -0.286) and Level III (0.045; 0.026 -0.079). Lower closure odds persisted across 14 binary sensitivity analyses while five separate multinomial sensitivity analyses supported the transfer association. Concerning timed direct arrivals and incoming transfers, 92.7% and 95.1%, respectively, underwent closure within 24 hours of reporting-hospital arrival.
Conclusion
Care pathways varied substantially by trauma center verification level, consistent with regionalized ophthalmic trauma care.