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Nitin Chopra, Kalla Gervasio, Albert Wu; Ophthalmic outcomes following gunshot wound to head. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5954. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
There has been limited research on gun trauma over the past two decades, despite the fact that firearm injuries in the U.S. account for a significant percentage of all injury deaths each year (16.8% in 2014). In particular, there have been few studies on ophthalmic outcomes following gunshot wounds to the head. The purpose of this retrospective cohort study was to assess how often patients who survive gunshot wounds to the head suffer permanent visual loss.
The Elmhurst City Hospital Trauma Registry and Mount Sinai Data Warehouse were queried for International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes for gun trauma resulting in ocular injury, and paper charts were obtained to evaluate ophthalmology notes. Between January 1, 2000 and May 8, 2016, we identified 31 patients who suffered a gunshot wound to the head and resultant ocular trauma, including orbital fracture, ruptured globe, foreign body, and optic nerve injury. Gun types included all firearms, air guns, and explosives. Of the 31 patients queried, four patients were excluded due to incorrect coding upon chart review, and five patients were excluded because their charts were missing. Data from the 22 remaining patients were then assessed.
Of 915 patients presenting to the Elmhurst and Mount Sinai Hospital Emergency Departments with injuries due to gun trauma, 27 (3.0%) sustained ocular injuries. Of the 22 patients whose records were accessible, four were noted to have ocular injury on presentation but then died in the operating room. Of the surviving 18 patients, 2 (11%) were shot directly in the eye, 5 (28%) were shot in the orbit, and 11 (61%) were shot elsewhere in the head. Neither location of injury (p = .243) nor type of gun used (p = .296) predicted visual loss outcome. Eight of the 18 surviving patients (44%) suffered permanent visual loss, defined as open globe injury requiring enucleation/evisceration or loss of vision due to traumatic optic neuropathy.
Loss of life from gun trauma is an issue that continues to attract national attention. However, even if one survives a gunshot wound to the head, we find that there is a high likelihood of suffering permanent visual loss. Though our dataset was limited, we found that visual loss outcome is not predicted by the location of gunshot wound or gun type used. Further research is needed to understand the full impact of gun trauma on ophthalmic outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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