Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99

Targeting safety: Exploring trends and risk factors in pediatric head and neck BB gun injuries and hospitalization

OBJECTIVE

To examine head and neck injuries caused by BB (Ball Bearing) guns treated in US emergency departments among children under 18 to identify trends in injury frequency over time and risk factors associated with severe injuries leading to hospital admission.

METHODS

This retrospective study utilized data from the National Electronic Injury Surveillance System (NEISS), a single database, to analyze head and neck injuries caused by BB guns between 1993 and 2019. The analysis explored demographic characteristics and injury patterns, including sex, age, incidence, injury location, hospital type, and disposition. Linear regression was employed to assess trends in the yearly frequency of injuries, while univariate and multivariate binary logistic regression was used to calculate the odds ratios associated with hospitalization.

RESULTS

A total of 4041 cases of pediatric head and neck injuries caused by BB guns and treated in US emergency departments were identified. Most patients were male (84 %), with the highest proportion of injuries occurring in the 10-14 age group (49.7 %). The face (35.8 %) and eye (27.4 %) were the most affected injury sites, and 7.5 % of patients required hospital admission. No significant linear trend was observed in injury frequency over the study period. However, children aged four and under had higher odds of hospitalization (OR 2.77, 95 % CI 1.61-4.75) despite a lower incidence of injuries. Injuries to the eye (OR 12.37, 95 % CI 8.31-18.43) and neck (OR 7.58, 95 % CI 4.76-12.06) were strong predictors of hospital admission.

CONCLUSION

Pediatric BB gun-related head and neck injuries remain a source of emergency room visits nationally. Younger children are at increased risk of admission to the hospital. Eye and neck injuries were the strongest predictors of hospital admission. Implementing safety precautions for younger children is crucial, as injuries might be more severe in this age group.

Epidemiology of Pediatric Nonballistic Firearm Injuries to the Upper Extremity in the United States From 2000 to 2017

Background: This study aimed to describe the epidemiology of pediatric upper extremity injury secondary to nonballistic firearms in the United States. Methods: The National Electronic Injury Surveillance Survey (NEISS) database was queried between 2000 and 2017 for injuries to the upper extremity from nonballistic firearms in patients aged ≤18 years. In total, 1502 unique cases were identified. Using input parameters intrinsic to the NEISS database, national weighted estimates were derived using Stata/IC 15.1 statistical software (StataCorp LLC, College Station, Texas), which yielded an estimate of 52 118 cases of nonballistic firearm trauma to the upper extremity who presented to US emergency departments over the study period. Descriptive statistics were performed using NEISS parameters. Results: An average of 2895 annual pediatric upper extremity nonballistic firearm injuries were identified between 2000 and 2017. Over 91% were sustained by men, and adolescents aged 12 to 18 were the most commonly injured (69.8%). Only 3.5% of all injuries required inpatient admission, and the most common sites of injury were the hand (41.1%), followed by fingers (35.9%). Conclusions: We conclude that nonballistic firearm injuries represent a significant burden of disease to adolescent men in the United States.

Navigation-guided neuroendoscopic removal of an intracranial migratory pellet from the thalamus of a 4-year-old girl

Extraction of a bullet fragment seated in deep brain parenchyma utilizing a neuroendoscope has not been previously reported in the literature. The authors report the case of a 4-year-old patient who presented after a pellet gun injury with a projectile located 6 cm intracranially and lodged within the posterior thalamus and near the posterior limb of the internal capsule. Initial operative repair included repair of a CSF leak with duraplasty, minimal brain debridement, and elevation of a depressed skull fracture. Subsequent CT at 2 months postoperatively revealed migration of the deep intracranial pellet. This finding correlated with intermittent worsening neurological symptoms and signs. A rigid 3-mm neuroendoscope with CT stereotactic navigation was then used to remove the pellet fragment from the thalamus. The patient returned home with alleviation of clinical symptoms and an uneventful postoperative recovery. This case demonstrates that navigation-guided neuroendoscopy can be successfully used to remove projectile fragments from deep brain structures, especially when the migration is along the initial path of the bullet. This technique represents another low-risk curative option in the management of retained bullet fragments in gunshot wound injuries to the head.

Air Guns: A Contemporary Review of Injuries at Six Pediatric Level I Trauma Centers

BACKGROUND

Studies spanning the last three decades demonstrated the injury causing capability of air gun (AG) projectiles. Recent studies have suggested the impact and incidence of these injuries may be declining because of edcational efforts. We hypothesize that injuries in the pediatric population resulting from AGs remain a significant health concern.

METHODS

A retrospective review (1/1/2007 to 12/31/2016), of AG-injured children < 19 years old, was performed across six level I Pediatric Trauma Centers, part of the ATOMAC research consortium. AG injuries were defined as injuries sustained by ball-bearing or pellet air-powered guns. Paint ball and soft foam AGs were excluded. Following institutional review board approval, patients were identified by ICD code from the trauma registry. Included were demographic data, injury severity scores, length of stay (LOS), outcome at discharge, and overall cost of admission. Descriptive statistics and parametric tests were employed.

RESULTS

A total of 499 patients sustained injuries. Mean age 9.5 (±4.0) y; 81% of victims were male; all survived to hospital discharge. 30% (n = 151) required operative intervention. Hospital LOS was 2.3 (±2.2) d; with mean cost of $23,756 (±$34,441). Injury severity score mean of 3.7 (±4.6) on admission. Over 40% of the injuries to the head/thorax that were severe (AIS ≥ 3) required operative intervention (P < 0.001).

CONCLUSIONS

AG injuries to the head or thorax seen at trauma centers were likely to require operative management. While no fatalities occurred, the cost was substantial. This study demonstrates pediatric injuries resulting from AG projectiles remain a significant health concern.

Nonpowder Firearm Injuries to Children Treated in Emergency Departments

OBJECTIVES

To investigate nonpowder firearm injuries treated in US emergency departments among children <18 years old.

METHODS

National Electronic Injury Surveillance System data from 1990 through 2016 were analyzed.

RESULTS

An estimated 364 133 (95% confidence interval 314 540-413 727) children <18 years old were treated in US emergency departments for injuries related to nonpowder firearms from 1990 to 2016, averaging 13 486 children annually. From 1990 to 2016, the number and rate of nonpowder firearm injuries decreased by 47.8% (P < .001) and 54.5% (P < .001), respectively. Most injuries occurred among 6- to 12-year-olds (47.4%) and 13- to 17-year-olds (47.0%). Boys accounted for 87.1% of injured children, the most common diagnosis was foreign body (46.3%), and 7.1% of children were admitted. BB guns accounted for 80.8% of injuries, followed by pellet guns (15.5%), paintball guns (3.0%), and airsoft guns (0.6%). The rate of eye injuries increased by 30.3% during the study period. Eye injuries accounted for 14.8% of all injuries and the most common diagnoses were corneal abrasion (35.1%), hyphema (12.5%), globe rupture (10.4%), and foreign body (8.6%).

CONCLUSIONS

Although the number and rate of nonpowder firearm injuries declined during the study period, nonpowder firearms remain a frequent and important source of preventable and often serious injury to children. The severity and increasing rate of eye injuries related to nonpowder firearms is especially concerning. Increased prevention efforts are needed in the form of stricter and more consistent safety legislation at the state level, as well as child and parental education regarding proper supervision, firearm handling, and use of protective eyewear.

Neurosurgical Care of Nonpowder Firearm Injuries: A Narrative Review of the Literature

Background

Nonpowder firearms discharge a projectile using compressed gases. Unlike traditional firearms, there is a perception that nonpowder guns do not cause serious injury. However, intracranial injury disproportionally affects children and can cause significant neurological disabilities and mortality. Management of nonpowder firearm injuries has received little attention in the literature and presents unique surgical challenges.

Materials and Methods

We conducted a narrative review of the literature of the management of nonpowder firearm injuries with particular emphasis on intracranial injury.

Results

Modern nonpowder firearms have muzzle velocities which are capable of penetrating the skin, eyes, and bone. Direct intracranial injury commonly results from entrance of projectile through thinner portions of the skull. Operative intervention is needed to debride and safely explore the trajectory to remove fragments which can easily cause neurovascular injury.

Conclusions

Neurosurgeons play a crucial role in managing serious nonpowder firearm injuries. A multidisciplinary team is needed to manage the direct results of penetrating injury and long-term sequalae.

Ball Bearing (BB) Gun Injuries

War game has become quite a popular recreational game in Hong Kong nowadays. Ball bearing (BB) and pellet gun-related injuries should not be overlooked. This article presented a case of BB gun-related soft tissue injury on the face with retained pellet. We also reviewed the types, power levels, and the injuries of non-power guns. The management of BB and pellet gun-related injuries and the preventive measures concerning legislation, education program, product safety awareness and protective gears usage would be emphasized.

A comparison between non-powder gun and powder-gun injuries in a young pediatric population

INTRODUCTION

Non-powder guns (NPG) are viewed as toys for children by the general public. Literature on firearm injuries in the pediatric population is increasing, however there are still large gaps in the published literature regarding NPG. We intended to identify and compare the epidemiology, circumstances of injury and outcomes of children with NPG versus powder-gun injuries (GSW).

PATIENTS AND METHODS

We performed a 6-year retrospective analysis of children 0-14 years old treated for NPG and GSW injuries at our level one pediatric trauma center. Mann-Whitney U test and Pearson's X² were used to compare continuous and categorical variables, respectively.

RESULTS

There were 43 NPG and 112 GSWs. Patients were predominantly male (36 children; 84%) NPG vs. 92 children; 82% GSW) with a median age in both groups of 11 years. Analysis of residential zip codes showed that 74% (32 children) NPG injuries and 85% (95 children) GSW lived in regions with higher poverty than the national level. Children with NPG injuries were more likely to be Caucasian (24 children; 56%) and to have suffered an unintentional injury (36 children; 84%), while children with GSW were African-American (80 children; 71%; p=0.0002) and victims of assault (50 children; 45%; p<0.0001). When compared with NPG, children with GSW had more severe injuries, longer hospital stays, and higher overall mortality. There were no significant differences in rate of emergent OR intervention and ED mortality between the two groups.

CONCLUSION

Our results highlight two important findings. First, NPG injuries were accidental and thus preventable with improved legislation and public education. Second, health disparities related to gun violence among African-Americans are prevalent even in early childhood and prevention efforts should include this younger population.

A 10-Year Analysis of Head and Neck Injuries Involving Nonpowder Firearms

Objectives

Firearms have an enduring and visible presence within American culture. However, the public health impact of nonpowder firearms and other “toy” guns has not been fully studied. These guns—including BB guns (ie, ball bearing), paintball guns, and pellet guns—are typically marketed to a younger audience. The objective of this study is to analyze head and neck injuries related to nonpowder firearms.

Study Design

Cross-sectional analysis of a national database.

Setting

Academic medical center.

Subjects and Methods

The National Electronic Injury Surveillance System was queried for head and neck injuries involving nonpowder guns, including air, BB, and pellet guns, and associated ammunition. Analysis of age, sex, incidence, injury location, and diagnosis was performed.

Results

From 2005 to 2014, there were 1695 cases recorded, or 55,060 estimated emergency room visits, due to injuries related to nonpowder guns and fired ammunition. The majority of patients were male (80.9%). These injuries were most common in children 6 to 12 years of age (37.9%), followed by those 13 to 18 years old (27.1%) and adults (≥19 years old; 17.8%), while preschool children (0-5 years) represented 17.2%. The most common injury diagnosis was penetrating foreign body (34.9%), followed by lacerations (24.3%) and contusions/abrasions (13.7%).

Conclusion

Nonpowder and other nonlethal firearm-related injuries to the head and neck region are a frequent source of emergency room visits nationally. Safety measures and public education on a mainstream level are required.

Auditory risk of air rifles

OBJECTIVE

To characterize the impulse noise exposure and auditory risk for air rifle users for both youth and adults.

DESIGN

Acoustic characteristics were examined and the auditory risk estimates were evaluated using contemporary damage-risk criteria for unprotected adult listeners and the 120-dB peak limit and LAeq75 exposure limit suggested by the World Health Organization (1999) for children.

STUDY SAMPLE

Impulses were generated by nine pellet air rifles and one BB air rifle.

RESULTS

None of the air rifles generated peak levels that exceeded the 140 dB peak limit for adults, and eight (80%) exceeded the 120 dB peak SPL limit for youth. In general, for both adults and youth, there is minimal auditory risk when shooting fewer than 100 unprotected shots with pellet air rifles. Air rifles with suppressors were less hazardous than those without suppressors, and the pellet air rifles with higher velocities were generally more hazardous than those with lower velocities.

CONCLUSION

To minimize auditory risk, youth should utilize air rifles with an integrated suppressor and lower velocity ratings. Air rifle shooters are advised to wear hearing protection whenever engaging in shooting activities in order to gain self-efficacy and model appropriate hearing health behaviors necessary for recreational firearm use.

The early hospital management of gunshot wounds. Part 1: head, neck and thorax

The management of gunshot wounds is an increasing problem for UK emergency doctors, but not to an extent where it has become routine or allowed individuals to gain significant experience in their treatment. This article reviews the pathophysiology of gunshot injury in general before examining the evidence available concerning the management of gunshot wounds to the head neck and thorax.

Epidemiology of Wire-Bristle Grill Brush Injury in the United States, 2002-2014

Objectives

The purpose of this study was to investigate the epidemiology of wire-bristle grill brush injury.

Study Design and Setting

Cross-sectional analysis of national databases; literature review.

Subjects and Methods

The Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) was used to derive a national weighted estimate of emergency department visits for wire bristle injury from 2002 to 2014. Date, location of injury, demographics, and outcomes were analyzed. A literature search and a consumer-reported injury database ( SaferProducts.gov ) were interrogated to provide ancillary sources of data.

Results

A total of 43 cases were found within the NEISS database, which extrapolated to an estimated 1698 (95% confidence interval, 1468-1927) emergency department visits nationwide. In the NEISS database, the mean age was 30 years, and the sex distribution of the patients was similar (21 males vs 22 females). The most common location of injury was the oropharynx in both the NEISS database (23 of 43, 53.4%) and the literature review (11 of 36, 30.5%). However, the oral cavity was the most frequent site in the consumer-reported SaferProducts.gov database (9 of 24, 37.5%). The majority of patients in the NEISS were treated in the emergency department (31 of 43, 69.7%). Raw case counts were highest in June, July, and August, with the highest number of events in the month of July.

Conclusion

Injury from wire-bristle grill brush is uncommon but prevalent during certain seasons. Otolaryngologists play an important in the diagnosis and treatment of these injuries. Awareness among consumers and product manufacturers is necessary to promote safety.

Penetrating head injuries in children due to BB and pellet guns: a poorly recognized public health risk

OBJECT Nonpowder guns, defined as spring- or gas-powered BB or pellet guns, can be dangerous weapons that are often marketed to children. In recent decades, advances in compressed-gas technology have led to a significant increase in the power and muzzle velocity of these weapons. The risk of intracranial injury in children due to nonpowder weapons is poorly documented. METHODS A retrospective review was conducted at 3 institutions studying children 16 years or younger who had intracranial injuries secondary to nonpowder guns. RESULTS The authors reviewed 14 cases of intracranial injury in children from 3 institutions. Eleven (79%) of the 14 children were injured by BB guns, while 3 (21%) were injured by pellet guns. In 10 (71%) children, the injury was accidental. There was 1 recognized assault, but there were no suicide attempts; in the remaining 3 patients, the intention was indeterminate. There were no mortalities among the patients in this series. Ten (71%) of the children required operative intervention, and 6 (43%) were left with permanent neurological injuries, including epilepsy, cognitive deficits, hydrocephalus, diplopia, visual field cut, and blindness. CONCLUSIONS Nonpowder guns are weapons with the ability to penetrate a child's skull and brain. Awareness should be raised among parents, children, and policy makers as to the risk posed by these weapons.

The Spectrum of Pediatric Orbital BB Gun Injuries: A Case Series

Three cases of pediatric BB orbital injury are reported demonstrating varying outcomes. Pediatric orbital BB injuries have a wide spectrum of clinical outcomes depending on the ocular structures involved. Improved safety education of patients and parents is necessary to reduce the burden of these vision-threatening injuries.

Air rifles are more than toys: BB gun-related traumatic brain injury

Gunshot wounds are traumatic events that emergency departments around the country treat on a daily basis. An increasing number of these wounds are being caused by air rifles that shoot ball bearings (ie, BB guns) and, although uncommon, the results can be fatal. The general public and most practitioners may not realize the damage these "toys" can inflict. This article highlights an unfortunate event involving a BB gun accidentally discharged at close range and the consequences. Data from recent and older studies are discussed regarding the firepower of these guns and their potential for injury.

Penetrated sigmoid colon by air gun pellet could be life threatening: A case report

INTRODUCTION

Air and paintball guns have been in existence for over 400 year. Although serious injury or death can result from the use of such guns, previous literature has not mentioned the issue of the penetration of the sigmoid colon by an air gun pellet.

PRESENTATION OF CASE

We report a rare case of a 44-year-old Caucasian woman referred to abdominal surgery after an accidental small wound had occurred in the lower left abdominal quadrant that was caused by an air gun pellet. The blood and biochemical analyses were normal but the CT scan revealed the presence of a foreign body – an air gun pellet in the left iliac region of the abdomen. Clinically, during the initial 24 h significant changes were not noticed. After 42 h, however, pain and local tenderness in the lower left abdominal quadrant was expressed. A laparotomy revealed a retained pellet in the wall of the sigmoid colon and a small leak with colonic content with consecutive local peritonitis also occurred. The foreign body was removed and the opening edges in the colon were excised and closed with the primary suture.

DISCUSSION

The hollow organs of the digestive tract, albeit very rarely penetrated by an air gun pellet, do not typically show all signs of an acute abdomen in the early posttraumatic phase. Such injuries can lead to a pronounced infection, which may cause septic shock if not appropriately treated.

CONCLUSION

For correct diagnosis, a careful approach and several daily clinical observations are required.

Ballistic parameters of .177 (4.5 mm) caliber plastic-sleeved composite projectiles compared to conventional lead pellets

The capability of conventional air gun lead pellets (diabolo pellets) to cause severe injuries or fatalities even at low kinetic energy levels is well documented in medical literature. Modern composite hunting pellets, usually a metal core (made of steel, lead, zinc, or a zinc and aluminum alloy) encased in a plastic sleeve, are of special forensic and traumatological interest. These projectiles are advertised by the manufacturers to discharge at higher velocities than conventional air gun pellets, thus generating very high tissue-penetrating capabilities. Lack of experimental data on these uncommon air gun projectiles induced this work. Ballistic parameters of 12 different caliber .177 (4.5 mm) composite pellets, discharged from two spring-piston air guns (Weihrauch HW 35, Webley CUB) and three pneumatic air guns (Walther LGR, Walther LG400, Walther LP300), were investigated using a ballistic speed measurement system and compared to a conventional diabolo pellet (RWS Meisterkugel) as reference projectile. Although overall results were inconsistent, for some projectile-weapon combinations (particularly spring-piston air guns), a significant change of the kinetic energy (-53 up to +48 %) to the reference projectile was observed. The data provided in this work may serve as a basis for forensic investigation as well as traumatological diagnosis and treatment of injuries caused by these uncommon projectiles.

Pediatric firearm injuries: a 10-year single-center experience of 194 patients

BACKGROUND

The objective was to investigate the relationship of high gun ownership and gun death rate on children and determine predictors influencing the incidence and outcome of pediatric firearm injuries in a major pediatric level 1 trauma center.

METHODS

We performed a retrospective review of our trauma registry to identify hospital admissions between April 1999 and March 2010. We extracted demographic and geographic data, seasonal variation, injury type, firearm type, and outcome.

RESULTS

We identified 194 firearm injuries. The incidence did not change during the past decade. Most occurred during the second half of the year (61.4%). Mean age was 12.2 ± 4.6 years (range, 0.4-19.2 years). Unintentional shootings accounted for 100 injuries followed by assaults (n = 55) and innocent bystanders (n = 39). African American children were most often injured because of a violent cause (60.3%), whereas white children were shot unintentionally (80.1%). Powder-propelled firearms caused 82.5% of injuries. Overall, 17.5% of children required an operation, and 9.3% died.

CONCLUSIONS

The overwhelming majority of children were injured after a gun went off unintentionally, whereas most African American children were shot violently. We identified certain seasonal and geographic clusters. These data can be used to target gun injury prevention programs.

Anesthesia for a thoracic BB gun injury

Pediatric anesthesiologists care for children with penetrating trauma from nonpowder (BB and pellet) guns. We present the case of a 9-year-old boy who required urgent median sternotomy for cardiac tamponade after sustaining a close-range BB gun injury to the chest. After summarizing the epidemiology of nonpowder gun injuries in children, we clarify the nomenclature, ballistics, and mechanisms of these guns, discuss the tendency to minimize these kinds of injuries, explain bullet embolization, and review (by body area) current clinical management issues.

Nonsurgical management of cardiac missiles

Modern air-powered pellet guns are capable of propelling their projectiles at velocities of 250 to 930 ft/s depending on their propulsion system-rivaling traditional small caliber firearms in the potential for serious soft tissue injuries. Management decisions regarding thoracic/cardiac pellet gun injuries must be based on the presentation and stability of the patient and the location of the retained pellet. We present a report of the nonsurgical management of an 8-year-old girl with a retained pericardial pellet and small stable effusion.

177 caliber pellet classification system and identification key

A classification system and identification key for .177 caliber air gun pellets was developed based on a five-class characteristic criterion. Sixty-eight pellet types from 15 companies were examined and compared. A classification system was developed based on the pellets' head shapes, skirt types, lengths, weights, and other markings or observations. In some cases, when a pellet is recovered from a crime scene, product brand identification may aid the investigation. Even though all product brands cannot be identified, various brands of pellets can be eliminated based on a pellet's class characteristics. The pellet producers in this study were located in the following countries: China, Czech Republic, England, Korea, Spain, and the United States. An identification key can be used for possible pellet identification or elimination.

Ball bearing (BB) guns, ease of purchase and potential for significant injury

INTRODUCTION

Ball bearing guns are used in the UK for war games, but they have the potential to cause severe injury if used incorrectly.

MATERIALS AND METHODS

A search was made for availability of these weapons, the ease of purchase and the potential for tissue damage.

RESULTS

These weapons are widely available on the Internet and are easy to purchase with no security checks. Once fully charged, an electric BB gun is capable of penetrating a cadaveric animal model at distances up to 5 m (1 m = 25 mm penetration, 3 m = 20 mm penetration, 5 m = 15 mm penetration).

CONCLUSIONS

BB guns are not toys and have a significant potential to cause injury.

Gun-related eye injury in the United States, 1993-2002

OBJECTIVE

To present the descriptive epidemiology of gun-related eye injury in the United States from 1993 through 2002.

METHODS

Data from the National Electronic Injury Surveillance System was used to estimate the number of patients treated in the United States for gun-related eye injury (GEI) (air guns and firearms), air gun-related eye injury (AEI) (BB/pellet guns and rifles) and firearm-related eye injury (FEI) (all powder discharge guns) during the time period 1993 through 2002. Rates were calculated according to age, gender, race, weapon type and circumstances surrounding the injury event (e.g., locale and intent).

RESULTS

The rate of gun-related eye injury in the United States declined to 7.5 per 1,000,000 in 2002 from 14.8 per 1,000,000 in 1993, representing a decline of approximately 5.4% per year (p = 0.0002), due primarily to a decline in the rate of FEI (6.7% per year, p = 0.029). The rate of AEI was relatively constant. GEI rates were highest among those aged 10-19 years, males, and Blacks. The overall rate of AEI was higher than the rate of FEI (6.0 per 1,000,000 and 5.1 per 1,000,000, respectively). According to race, the rate of FEI was higher than the rate of AEI in Blacks whereas the rate of AEI was higher than the rate of FEI in Whites and Hispanics. The majority of GEIs occurred at home and were unintentional.

CONCLUSION

The rate of gun-related eye injury in the United States declined from 1993 through 2002 primarily due to a reduction in firearm-related eye injury, whereas the rate of air gun-related eye injury remained constant. Persons who were young, Black, and male were at highest risk for gun-related eye injury.

Injury risk of nonpowder guns

Nonpowder guns (ball-bearing [BB] guns, pellet guns, air rifles, paintball guns) continue to cause serious injuries to children and adolescents. The muzzle velocity of these guns can range from approximately 150 ft/second to 1200 ft/second (the muzzle velocities of traditional firearm pistols are 750 ft/second to 1450 ft/second). Both low- and high-velocity nonpowder guns are associated with serious injuries, and fatalities can result from high-velocity guns. A persisting problem is the lack of medical recognition of the severity of injuries that can result from these guns, including penetration of the eye, skin, internal organs, and bone. Nationally, in 2000, there were an estimated 21840 (coefficient of variation: 0.0821) injuries related to nonpowder guns, with approximately 4% resulting in hospitalization. Between 1990 and 2000, the US Consumer Product Safety Commission reported 39 nonpowder gun-related deaths, of which 32 were children younger than 15 years. The introduction of high-powered air rifles in the 1970s has been associated with approximately 4 deaths per year. The advent of war games and the use of paintball guns have resulted in a number of reports of injuries, especially to the eye. Injuries associated with nonpowder guns should receive prompt medical management similar to the management of firearm-related injuries, and nonpowder guns should never be characterized as toys.

Injuries from paintball game related activities in the United States, 1997-2001

OBJECTIVE

To quantify and characterize injuries resulting from paintball game related activities among persons >/=7 years in the United States.

SETTING

Hospitals included in the National Electronic Injury Surveillance System (NEISS); these are composed of a stratified probability sample of all hospitals in the United States with emergency departments.

METHODS

Using NEISS, non-fatal injury data for paintball game related injury cases from 1997-2001 were obtained from emergency department records. Participation estimates used to calculate injury rates were obtained from a yearly survey funded by the National Sporting Goods Association.

RESULTS

An estimated 11 998 persons >/=7 years with paintball game related injuries were treated in emergency departments from 1997-2001, with an annual average rate of 4.5 per 10 000 participants (95% confidence interval 3.3 to 5.7). The paintball game related injury rate was highest for 18-24 year olds (4.9 per 10 000 participants) and most injuries (94.0%) occurred among males. Almost 60% of all injured persons >/=7 years were treated for paintball pellet wounds of which most were to the eye. While 76.9% of injured persons ages 7-17 years were treated for paintball pellet wounds, almost 40% of those >/=18 years were treated for injuries resulting from overexertion or a fall. Lower extremity injuries were also common (23.0%), mostly from overexertion. Most injured persons (95.5%) were treated and released.

CONCLUSIONS

As paintball games become more popular, efforts are needed to increase training, enforce rules, and educate participants about how to stay safe, such as wearing protective eye gear, when engaged in paintball games at home, in a public area, or in a sports field.

Nonfatal and fatal firearm-related injuries among children aged 14 years and younger: United States, 1993-2000

OBJECTIVE

To provide national estimates of fatal and nonfatal firearm-related (FA) injuries among children < or =14 years old and to examine the circumstances under which these injuries occurred.

METHODS

For nonfatal FA injuries among children, we analyzed data on emergency department (ED) visits from the National Electronic Injury Surveillance System for 1993 through 2000. National estimates of injured children who were treated in hospital EDs were examined by selected characteristics, such as age, gender, race/ethnicity of the patient, primary body part affected, intent of the injury, the relationship of the shooter to the patient, where the injury occurred, and activity at the time of injury. For fatal FA injuries among children, we analyzed mortality data from the National Vital Statistics System for 1993 through 2000. Data from both sources were used to calculate case-fatality rates.

RESULTS

From 1993 through 2000, an estimated 22,661 (95% confidence interval [CI]: 16,668-28,654) or 4.9 per 100,000 (95% CI: 3.6-6.2) children < or = 14 years old with nonfatal FA injuries were treated in US hospital EDs. Assaults accounted for 41.5% of nonfatal FA injuries, and unintentional injuries accounted for 43.1%. Approximately 4 of 5 children who sustained a nonfatal, unintentional FA injury were reportedly shot by themselves or by a friend, a relative, or another person known to them. During this period, 5542, or 1.20 per 100,000 (95% CI: 1.17, 1.23), children < or =14 years old died from FA injuries; 1 of every 5 children who were wounded by a firearm gunshot died from that injury. Most FA deaths were violence related, with homicides and suicides constituting 54.7% and 21.9% of these deaths, respectively. For individuals < or =14 years old, the burden of morbidity and mortality associated with FA injuries falls disproportionately on boys, blacks, and children 10 to 14 years old. Both fatal and nonfatal injury rates declined >50% during the study period.

CONCLUSIONS

Although rates of nonfatal and fatal FA injuries declined during the period of study, FA injuries remain an important public health concern for children. Well-designed evaluation studies are needed to examine the effectiveness of potential interventions aimed at reducing FA injuries among children.

Air-Gun Injuries: Initial Evaluation and Resultant Morbidity

Severity of injuries from air-powered weapons can be underappreciated. Transformation of these weapons into toys makes them available to children. Our experience reveals the underestimated injury severity and emphasizes need for prompt trauma evaluation. Retrospective chart review of children sustaining air-gun injuries and evaluated at a single, pediatric hospital from 1991 to 2002 was performed. Medical record numbers were retrieved from a trauma data base. Data included age, weapon type, firing distance, injury site, radiographic studies, operative intervention, length of stay, and long-term disability. Ocular injuries were excluded secondary to known severity. All other injuries and treatments are described. Thirty-four children, average age 10 years ± 3.3 years, sustained 35 injuries from 1991 through 2002. Twenty-one children required admission, 19 children required surgery, and 5 children experienced long-term disability. Average time to definitive care was 3 hours 12 minutes. Sites of injury included head, neck, chest, abdomen, and extremities. Average hospital stay was 4.3 days. In the pediatric population, air-gun injuries can be underestimated. Lack of collateral tissue damage makes wounds appear innocuous to unsuspecting medical personnel resulting in delayed care. During initial evaluation, injuries from air guns deserve the same respect as those caused by conventional firearms.