• Firearm-Related Ocular Trauma in Children and Adolescents

    Written By: Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, December 2019

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    Weiss et al. evaluated the epidemiologic pattern of firearm-related ocular injuries in young people. They found that more than half of the injuries were associated with traumatic brain injury, and 12% of the injuries resulted in death.

    For this retrospective analysis, the authors used records from the National Trauma Data Bank from 2008-2014. Of note, the data bank includes most U.S. trauma centers; however, it does not include emergency departments in other hospitals.

    Of the 8,715 firearm-related ocular injuries leading to hospitalization during this time, 1,972 (22.6%) were in people under 21 years of age. Collected data included age, sex, race/ethnicity, injury intent, disease/injury classifica­tion codes, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, geographic location, length of hospital stay, health insurance status, and disposition at discharge.

    Results showed that most of the pediatric patients were male (85.1%) and adolescents (52.6%), with a mean age of 15.2 years. Most commonly, the injuries occurred at home (38.6%) or on the street (24.8%). The mean (stan­dard deviation) hospital stay was 7.6 (12) days, ISS was 16 (13.1), and GCS score was 11 (5.1).

    The most common ocular injuries were open wound of the eyeball (41.6%), ocular adnexa (25.5%), orbital injury or fracture (30.0%), and contusion of the eye or adnexa (21.1%). The youngest group of patients (≤4 years of age) was most likely to be injured unintentionally (odds ratio [OR], 4.41; p < .001) and at home (OR, 5.39; p < .001). The oldest group (19-21 years) had the highest odds of assault injury (OR, 2.17; p < .001) and injury in the street (OR, 1.61; p < .001).

    Injuries among black patients were more likely to be the result of an assault (OR, 4.53; p < .001); in contrast, inju­ries among white patients were more likely to be self-inflicted (OR, 7.1; p < .001). Most cases of traumatic brain injury resulted from self-inflicted harm (OR, 5.99; p < .001), as did most visual pathway injuries (OR, 2.86; p < .001). The mortality rate for inpatients was 12.2%. (Also see related commentary by Joseph K. Canner, MHS; Joseph V. Sakran, MD, MPH, MPA, and Fasika Woreta, MD, in the same issue.)

    The original article can be found here.