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Original Investigation
October 10, 2019

Patterns of Pediatric Firearm-Related Ocular Trauma in the United States

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
  • 2Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York
  • 3Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Boston
  • 4Department of Surgery (Trauma), Jacobi Medical Center, Bronx, New York
  • 5Department of Surgery (Ophthalmology), Jacobi Medical Center, Bronx, New York
JAMA Ophthalmol. Published online October 10, 2019. doi:10.1001/jamaophthalmol.2019.3562
Key Points

Question  What is the epidemiologic pattern of firearm-related ocular trauma in the pediatric population in the United States?

Findings  In this analysis of 1972 firearm-related ocular injuries recorded in the National Trauma Data Bank, almost a quarter of all such injuries between 2008 and 2014 occurred in the pediatric population, mostly among male adolescents 12 to 18 years of age. Although most firearm-related ocular injuries occurred in white patients, male black adolescents were represented disproportionately.

Meaning  The study findings suggest that pediatric firearm-related ocular injuries may be associated with substantial morbidity and mortality; identifiable risk factors in vision loss among children included race/ethnicity, sex, and age group.


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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