Firearm-Related Pediatric Ocular Trauma: Analysis of Patterns in the United States
Rebecca S. Weiss; Ryan Gise; Dave Poulsen; Afshin Parsikia; Joyce N. Mbekeani
Introduction: Firearms rank second amongst causes of pediatric trauma-related injuries in the US, resulting in mortality and significant morbidity. We aimed to evaluate pediatric firearms-related ocular injuries (FOI).
Methods: We identified pediatric patients (<21years), hospitalized with FOI, using ICD-9 codes from the National Trauma Data Bank (2008-2014). Tabulated data was analyzed using student’s t and chi-squared tests and regression analysis with SPSS software. Significance was set at p<0.05.
Results: 1,972 (22.6%) of 8,715 FOI occurred in pediatric patients. The majority (52.6%) were 12-18years old. Mean (SD) age was 15.2(5)years in males and 16.4(4.1)years in females. Males represented 85.1%, Whites, 33%, Blacks, 43.2% and Hispanics, 18.9%. Common locations were home, 38.6% and street, 24.8%. Mean (SD) hospital stay was 7.6(12)days, injury severity score was ‘severe,’ at 16(13.1) and GCS was 11(5.1). Common injuries were open wound of eyeball (41.6%) and ocular adnexa (25.5%) and orbital fractures (30%). The 0-3years group had greater odds of unintentional injuries (OR=4.41; CI=2.51-7.75) and home location (OR=5.39; CI=2.81-10.38); p<0.001 while the 19-21years group had greatest odds of assault (OR=2.17; CI=1.77-2.66) and street location (OR=1.61; CI=1.3-1.98); p<0.001. Blacks had greater odds of assault (OR=4.35; CI=3.68-5.59) and Whites, self-inflicted injury (OR=7.1; CI=5.92-9.51); p<0.001. Traumatic brain injury, TBI, (55.3%) resulted mostly from self-inflicted trauma (OR=5.99; CI=4.16-8.63) as did visual pathway injuries (OR=2.86; CI=1.95-4.2) p<0.001. Mortality rate was 12.2%.
Discussion: FOIs are predominantly sight-threatening and are associated with TBI. Identifiable risks include gender, age, race and intention.
Conclusion: Description of pediatric FOIs and risk factor identification can help us develop focused intervention strategies.