Citation

Canner JK, Sakran JV, Woreta F. JAMA Ophthalmol. 2019; ePub(ePub): ePub.

Affiliation

Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.

Copyright

(Copyright © 2019, American Medical Association)

DOI

10.1001/jamaophthalmol.2019.3587

PMID

31600367

Abstract

Firearm injuries are a public health crisis in the United States. The mainstream media highlights the senseless mass shootings that continue to happen, yet that is just the tip of the iceberg. The lack of federal dollars appropriated to this epidemic over the past 25 years has limited the ability of researchers to develop data-driven solutions at a level commensurate with the burden of injury. In this issue of JAMA Ophthalmology, Weiss et al1 report on pediatric patients with firearm-related ocular injuries (FOIs), a group of patients for whom the effect of vision loss is particularly devastating. Using National Trauma Data Bank (NTDB) records from 2008 to 2014, the authors found that almost a quarter of all FOIs occurred in the pediatric population, mostly in boys and adolescents. More than half were associated with traumatic brain injury and 12% of the injuries resulted in death. Injuries among black individuals were more likely due to assault, whereas injuries among white individuals were more likely self-inflicted.

The NTDB is a useful source of information on pediatric firearm-related ocular injuries, as it includes information not available in national administrative data sets, such as race/ethnicity and vital signs. However, the NTDB is a convenience sample of trauma centers throughout the United States.2 While it includes most US trauma centers, it does not include emergency departments in hospitals that are not designated as trauma centers. By contrast, the Health Cost and Utilization Project Nationwide Emergency Department Sample (NEDS)3 is a 20% sample of all hospital-based emergency departments in the United States and can generate accurate estimates of the national burden of injury. When the International Classification of Diseases, Ninth Revision (ICD-9) code criteria from Weiss et al1 are applied to the NEDS, there are an average of 2898 pediatric FOIs annually from 2008 to 2014 compared with 282 in Weiss et al study. This difference is mostly explained by the presence of an average of 2440 unintentional air gun and paintball gun injuries (ICD-9 codes E922.4 and E922.5) annually. Nearly three-quarters of these injuries (71.2%) were contusions or superficial injuries and nearly half (45.7%) were treated at nontrauma centers. Thus, the Weiss et al study likely underestimates the number of pediatric FOIs. We believe it may be challenging to reproduce their results to better understand the differing estimates in the NTDB and the NEDS because the precise inclusion and exclusion criteria may not be as clear as possible ...

Language: en