The Ocular Trauma Score.

Relatively junior doctors or allied health workers, with little or no training in ophthalmology, are often tasked with the recognition and initial management of eye trauma. In these situations, the lack of clear instructions and guidance to support decision making has been a key challenge, which has been compounded by the inconsistent terminologies used to describe eye injuries. In order to standardise the description of mechanical eye injuries (excluding those caused by chemicals, electricity or heat), and to link the correct management to the actual clinical situation, an Ocular Trauma Classification Group was convened in 1997. The group reviewed trauma classification systems in ophthalmology and general medicine1 and then developed the Birmingham Eye Trauma Terminology System (BETTS) (see page 43). This became established as a standardised terminology used to describe and share eye injury information, and it has been particularly useful in the management of trauma cases in a multidisciplinary environment (pages 42 –43). Next, the Ocular Trauma Classification Group analysed more than 100 variables for over 2,500 eye injuries recorded in the United States and Hungarian Eye Injury Registries in order to identify the best predictors of outcome at 6 months after injury. From this, they developed the Ocular Trauma Score (OTS), which is used to predict the visual outcome of patients after open-globe ocular trauma. The score’s predictive value is used to counsel patients and their families and to manage their expectations. It provides guidance for the clinician before pursuing complex, sometimes expensive interventions, particularly in resource-limited settings. OTS scores range from 1 (most severe injury and worst prognosis at 6 months follow-up) to 5 (least severe injury and least poor prognosis at 6 months). Each score is associated with a range of predicted post-injury visual acuities. It has a predictive accuracy of approximately 80%, which means that the OTS will be accurate 4 out of 5 times. PROGNOSIS