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. 2023 Apr-Jun;16(2):43-47.
doi: 10.4103/jets.jets_165_21. Epub 2023 May 30.

Utilization of Ophthalmic Management in Patients with Head-and-Neck Trauma Secondary to Firearms

Matthew Allen De Niear  1 , Vincent Duong Tang  1 , Michael Nguyen  1 , Lily Koo Lin  1
Affiliations

Utilization of Ophthalmic Management in Patients with Head-and-Neck Trauma Secondary to Firearms

Matthew Allen De Niear et al. J Emerg Trauma Shock. 2023 Apr-Jun.

Abstract

Introduction: This retrospective cohort study presents the epidemiology of severe firearm-related ophthalmic injury and the level of ophthalmology involvement in the multidisciplinary management of head-and-neck gunshot injuries.

Methods: A retrospective study identified 207 patients with firearm-related injuries involving the head and neck treated at an Academic Tertiary Care Institution from 2010 to 2020.

Results: Ophthalmology consulted on 29% of patients with head-and-neck firearm injuries. At least one of the services managing facial trauma (plastic surgery and otolaryngology) consulted on 71.5% of cases (P < 0.001). Of patients evaluated by ophthalmology, 93.3% survived to discharge; 78.2% of patients who were not evaluated survived to discharge (P = 0.009). Ophthalmology consulted on all patients with open globe injury (10.6%) (P < 0.001), all of which were evaluated by the facial trauma service (P = 0.002), 77.3% by otolaryngology (P = 0.42), 50% by neurosurgery, 36.4% by plastic surgery, 13.6% by orthopedic surgery, and 4.5% by vascular surgery. Ophthalmology consulted on 76.5% of patients with orbital fracture (32.9%) (P < 0.001); 83.8% were evaluated by the facial trauma service (P = 0.006), 69.1% by otolaryngology (P = 0.014), 54.4% by neurosurgery, 27.9% by plastic surgery, 10.3% by orthopedic surgery, and 2.9% by vascular surgery. For patients with orbital fractures, 92.3% survived when ophthalmology was consulted (P = 0.698); 43.8% survived when not consulted (P = 0.001).

Conclusions: Firearm-related injuries of the head and neck frequently involve ocular and orbital structures, often causing serious vision-threatening injuries. Multispecialty management is common and early ophthalmology specialist evaluation and co-management are indicated to best identify ophthalmic injuries.

Keywords: Emergency medicine; firearm injuries; gunshot wounds; open globe injury; ophthalmology; orbital fractures.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patient characteristics by race, (a) ethnicity, (b) and intention of injury (c)
See this image and copyright information in PMC

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