Comparative evaluation of three trauma scoring systems: OTS, POTS, and MPOTS for predicting early visual outcomes in pediatric open-globe injuries.

Objective: To evaluate and directly compare the prognostic performance of three trauma scoring systems-Ocular Trauma Score (OTS), Pediatric Ocular Trauma Score (POTS), and Modified Pediatric Ocular Trauma Score (MPOTS)-in predicting visual outcomes in pediatric patients with open-globe injuries (OGI).

Methods: This retrospective cohort included 110 pediatric patients (≤ 18 years) who underwent surgical repair for OGI between January 2018 and December 2024. Demographic, clinical, and surgical data were extracted from standardized medical records. Prognostic factors for final visual acuity (VA) were analyzed, and OTS, POTS, and MPOTS were calculated for each patient. Visual outcomes were classified as favorable (VA > 20/200) or poor (VA ≤ 20/200). Predictive performance was assessed using Spearman's rank correlation and receiver operating characteristic (ROC) curve analysis.

Results: The mean age was 7.85 ± 4.73 years, and the mean follow-up was 20.36 ± 16.70 months. Presenting VA, injury zone, and associated ocular pathologies (hyphema, traumatic cataract, vitreous hemorrhage, retinal detachment, choroidal involvement, vitreous prolapse, and iris prolapse) were significant predictors of poor outcomes (all p < 0.05), whereas age, sex, and time to surgery were not. Mean VA improved significantly from baseline (1.40 ± 0.92 logMAR) to final follow-up (0.68 ± 1.04 logMAR; p < 0.001). All three trauma scores correlated strongly with final VA, with OTS (r = - 0.822) and POTS (r = - 0.807) outperforming MPOTS (r = - 0.690). ROC analysis confirmed excellent discriminative ability for all three models, with the highest areas under the curve (AUC) observed for POTS (0.983), followed by OTS (0.974) and MPOTS (0.948).

Conclusions: OTS, POTS, and MPOTS are valuable tools for predicting visual outcomes in pediatric OGI. While POTS demonstrated the best discriminative performance in our cohort, OTS remained highly reliable, and MPOTS provided a simpler framework but with slightly reduced accuracy. OTS should continue to serve as a reference standard, with pediatric-specific scores offering complementary value in challenging clinical scenarios.