Incidence and Characteristics of Orbital Hemorrhages in the United States from 2006 to 2018

Purpose: To determine the incidence, characteristics, and costs associated with orbital hemorrhages presenting to US EDs. Patients and Methods: This was a retrospective, longitudinal study of the Nationwide Emergency Department Sample, 2006 to 2018. Medical records from patients presenting to participating hospital-owned EDs and diagnosed with primary or secondary orbital hemorrhage were examined to determine incidence, demographics, clinical characteristics, mechanism, disposition and related risk factors, and costs. Results: From 2006 to 2018, an estimated 20,762 US ED visits included an orbital hemorrhage diagnosis. Most primary diagnosis patients were elderly (35%) and male (51%), and incidence increased from 1.1 (95% CI: 0.8–1.4) to 3.1 per million (95% CI: 2.5– 3.7, p < 0.0001). Fall was the most common mechanism (21.6%), particularly among the elderly (39.9%). Fall-related diagnoses increased from 0.03 (95% CI: −0.01–0.07) to 1.0 per million (95% CI: 0.7–1.3, p < 0.0001), while overall falls increased by only 7%. Assault-related orbital hemorrhage increased from 0.1 (95% CI: 0.0–0.2) to 0.6 per million (95% CI: 0.4–0.7, p < 0.0001), while overall assaults decreased by 22%. Annual total ED costs increased from $463,220 (95% CI: 233,993–692,446) to $6,117,320 (95% CI: 4,665,403–7,569,237, p < 0.001). Inpatient admission was uncommon (9.0%), but related costs totaled $18.9 million (95% CI: 13.3–24.5). Odds of admission were lower in fall-and objects-related injuries and higher with certain concurrent injuries. Conclusion: Orbital hemorrhages are becoming more frequent and costly. A disproportionately large increase in fall-and assault-related diagnoses highlights the need for targeted injury prevention strategies to reduce cost and morbidity.