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Timothy Truong, Catherine He, Afshin Parsikia, Joyce Mbekeani; Spectrum of Firearms-Associated Ocular Injuries. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2304.
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Vision loss in one or both eyes constitutes 24% and 85% whole-person disability, respectively. Firearms, a leading cause of ocular trauma with devastating outcomes, contribute to such disability and billions of dollars in annual healthcare costs. However, few studies have been done that address firearms-associated ocular injuries (FAOI). We aim to characterize the spectrum of FAOI in the United States.
A retrospective study of the National Trauma Data Bank (2008-2014) was conducted. Patients with FAOI were identified using ICD-9 codes. Statistical analysis was performed with SPSS software using student’s t-test, Chi-squared and odds ratios (OR) to assess association of variables. Significance was set at p<0.05.
8,715 (3.7%) of 235,254 patients admitted with firearms injuries had FAOI. Most were male (85.7%) and White (46.6%); 35% were Black. Common injuries were orbital, 38.6%, open globe, 34.7%, and contusions of eye/ adnexa, 22.2%. Patients <10yrs were more likely to have open globe (OR 1.84; CI 1.40-2.41; p<0.001) while those 51-60yrs and 71-80yrs had higher odds of orbital injuries (OR 1.33; CI 1.14-1.55; p<0.001) and contusions (OR 1.53; CI 1.14-2.06; p=0.004), respectively. Whites had increased odds of orbital (OR 1.32; CI 1.21-1.44; p<0.001) and contusions (OR 1.18; CI 1.06-1.3; p=0.002), and Blacks, open globe (OR 1.12; CI 1.02-1.23; p=0.02) and open adnexa injuries (OR 1.33; CI 1.19-1.48; p<0.001). There were no significant gender differences in the types of injuries incurred. Unintentional FAOI were most associated with open globe (OR 1.88; CI 1.62-2.17), self-inflicted with optic nerve (OR 1.82; CI 1.56-2.14), and assault with other cranial nerve injuries (OR 1.78; CI 1.47-2.16; p<0.001). The mean hospital stay was 9.8 (SD 14.6) days; optic nerve injury had the highest odds of >6 day stay (OR 2.59; CI 2.21-3.04; p<0.001). Very severe injury severity scores (>24) (OR 1.49; CI 1.34-1.66; p<0.001) and Glasgow coma scores (<8) (OR 1.47; CI 1.32-1.63; p<0.001) were most associated with contusions. Overall, traumatic brain injury (TBI) was reported in 64.6%. Mortality rate was 16.2%.
Firearms mostly caused orbital, open globe and contusion injuries; most had TBI. Types of injury were associated with demographic characteristics and intention. Awareness of the scope of FAOI will help reveal the full impact of firearms in ophthalmology and assist with appropriate prevention and management.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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