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Patterns of Pediatric Firearm-Related Ocular Trauma in the United States
Rebecca Weiss1,2, Catherine He2, Ryan Gise3
1Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York.
Insights
Pediatric firearm-related ocular injuries are a significant public health concern, often leading to vision loss and traumatic brain injury. Understanding risk factors like age and intent is crucial for developing prevention strategies.
Area of Science:
- Public Health
- Ophthalmology
- Trauma Surgery
Background:
- Firearm violence is a major public health issue in the U.S.
- Ocular trauma from firearms can cause severe vision loss.
- Little is known about pediatric firearm-related ocular injuries.
Purpose of the Study:
- To evaluate the epidemiologic patterns of pediatric firearm-related ocular injuries.
- To identify demographic and injury characteristics.
- To inform prevention strategies.
Main Methods:
- Retrospective analysis of the National Trauma Data Bank (2008-2014).
- Included pediatric patients (<21 years) with firearm-related ocular injuries (n=1972).
- Collected data on demographics, injury type, intent, location, and outcomes.
Main Results:
- 22.6% of firearm-related ocular injuries occurred in pediatric patients, predominantly males (85.1%) and adolescents (52.6%).
- Common injury locations were home (38.6%) and street (24.8%).
- Younger children (0-3 years) had higher odds of unintentional home injuries, while older adolescents (19-21 years) had higher odds of assault injuries.
Conclusions:
- Pediatric firearm-related ocular injuries are sight-threatening and often associated with traumatic brain injury.
- Risk factors vary by age and race/ethnicity.
- Findings can guide the development of targeted prevention strategies.
Importance:
Gun violence represents a substantial public health issue, and firearm-related injuries rank second among the causes of injury-related deaths in children aged 0 to 17 years in the United States. Ocular trauma from firearm-related injuries can lead to devastating vision loss, but little is known to date about the specific demographics and characteristics of such injuries in children.
Objective:
To evaluate the epidemiologic pattern of pediatric firearm-related ocular injuries.
Design, Setting, And Participants:
This retrospective analysis used deidentified data from the National Trauma Data Bank, the largest national registry of hospitalized trauma cases in the United States. The firearm-related ocular injuries (n = 1972) of pediatric patients (defined as those younger than 21 years) hospitalized between January 1, 2008, and December 31, 2014, were analyzed. Statistical analyses were conducted from July 15, 2017, to June 15, 2019.
Exposure:
Firearm-related ocular trauma.
Main Outcomes And Measures:
Pediatric patients with firearm-related ocular injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and external causes of injury codes. Patient demographics (age, sex, and race/ethnicity), type of ocular injury, injury intent, geographic location, length of hospital admission, health insurance status, disposition at discharge, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were collected.
Results:
A total of 8715 firearm-related ocular injuries were identified. Of these injuries, 1972 (22.6%) occurred in pediatric patients, most of whom were male (1678 [85.1%]) and adolescents (1037 [52.6%]), with a mean (SD) age of 15.2 (5) years. Common locations of injury were home (761 [38.6%]) and street (490 [24.8%]). Mean (SD) hospital length of stay was 7.6 (12) days, ISS was 16 (13.1), and GCS score was 11 (5.1). The most common types of firearm-related ocular injuries were open wound of the eyeball (820 [41.6%]) and ocular adnexa (502 [25.5%]), orbital injuries or fractures (591 [30.0%]), and contusion of the eye or adnexa (417 [21.1%]). Patients aged 0 to 3 years had greater odds of unintentional injuries (odds ratio [OR], 4.41; 95% CI, 2.51-7.75; P < .001) and injuries occurring at home (OR, 5.39; 95% CI, 2.81-10.38; P < .001), and those aged 19 to 21 years had greater odds of assault injuries (OR, 2.17; 95% CI, 1.77-2.66; P < .001) and injuries occurring on the street (OR, 1.61; 95% CI, 1.3-1.98; P < .001). Black patients had the greatest odds of having injuries with assault intention (OR, 4.53; 95% CI, 3.68-5.59; P < .001), and white patients had the greatest likelihood for self-inflicted injury (OR, 7.1; 95% CI, 5.92-9.51; P < .001). Traumatic brain injury resulted mostly from self-inflicted trauma (OR, 5.99; 95% CI, 4.16-8.63; P < .001), as did visual pathway injuries (OR, 2.86; 95% CI, 1.95-4.20; P < .001). The inpatient mortality rate was 12.2%.
Conclusions And Relevance:
This study found that pediatric firearm-related ocular injuries from 2008 through 2014 were predominantly sight-threatening and associated with traumatic brain injury. If the possible risk factors, including sex, age, race/ethnicity, and injury intention, can be confirmed for 2015 through 2019, these findings may be useful in developing strategies to prevent pediatric firearm-related ocular injuries.
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