Firearms, air guns, and paintball: an epidemiological study of traumatic shooting injuries to the eye

Abstract

Introduction
Shooting-related ocular trauma (OT) is often severe and sight threatening. We characterized and compared ocular trauma caused by firearms (FAOT), paintball guns (PBOT), and air-guns (AGOT).
Methods
OT were identified and retrospectively studied using International Classification of Diseases, 9th Rev, Clinical-Modification, from the National Trauma Data Bank 2007-2015. 
Results
Of 714,633 OT cases, we identified 27,592 (3.86%) FAOT, 2057 (0.30%) AGOT, and 169 (0.02%) PBOT. Children, age (IQR) 13 years (10-17), comprised most of AGOT, whereas adolescents 19 years (15-27), and young adults 29 years (20-44) predominated PBOT and FAOT, respectively. Males were disproportionally involved in FAOT and AGOT six times, and in PBOT nine times, more often than females. The odds of Black to White patients involved in FAOT was three times, and in AGOT two times, higher than in other injuries. AGOT and FAOT occurred predominantly at home (62.3% and 46.8%, resp.) while PBOT in recreational facilities (39.6%). FAOT had the highest mean injury-severity-score and hospital stay of 18.0 and 10.17 days, respectively. Although the mean risk of OT in firearms-related injuries, predominantly in the chest and hip, was relatively low (2.71 in 100 cases admitted to ED), it was very high in paintball (46.4) or air-gun injuries (22.4), which mostly involved the head and face. The frequencies of FAOT and AGOT has been trending up each year (P < 0.0001). The risk of OT in gun-related accidents did not change significantly over the period (P > 0.30).
Conclusions
Recreational toy guns have higher risk of causing OT than firearms. Young boys were at highest risk of OT in air-gun accidents at home, and adolescent males in paintball accidents at recreational facilities. Guidelines are needed for the sale and use of dangerous recreational guns; particularly since air-gun-related OT has been trending up 2007-2015.