Study finds increase in pediatric eye injuries from nonpowder firearms

November 25, 2019

Nonpowder firearms have long been marketed to children and teenagers as toys or "starter" firearms and include BB, pellet, airsoft and paintball guns. A new study conducted by researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children's Hospital investigated nonpowder firearm injuries treated in U.S. emergency departments (EDs) among children younger than 18 years from 1990 through 2016. It found an overall decrease in the rate of nonpowder firearm injuries during the study period, but an increasing rate of eye injuries related to nonpowder firearms.

The study, published today in Pediatrics, found an estimated 364,133 children were treated in U.S. EDs for injuries related to nonpowder firearms during the study period, going from 16,456 injuries in 1990 to 8,585 injuries in 2016. BB guns accounted for 81% of the injuries. While the number of injuries decreased by 48% during the study period, in 2016 there was still a child treated every hour in the U.S.

"While it is good to see that the overall number of injuries from nonpowder firearms is going down, it is important to note that they remain a frequent and important source of preventable and often serious injury to children," said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children's. "The severity and increasing rate of eye injury related to nonpowder firearms is especially concerning. One way to help reverse this trend is to make sure that protective eyewear is worn every time nonpowder firearms like BB, pellet, airsoft and paintball guns are used."

Eye injuries accounted for 15% of nonpowder firearm injuries and the number of eye injuries increased by 50% during the study period. These injuries were often serious, with 22% requiring admission to the hospital. The most common eye injury-related diagnoses were corneal abrasion (35%), hyphema (13%), globe rupture (10%) and foreign body (9%). These injuries can result in serious adverse outcomes, including partial or complete vision loss.

The average age of children with a nonpowder firearm injury was 12 years. Among cases where the type of firearm could be determined, BB guns accounted for 81% of injuries, followed by pellet guns (16%), paintball guns (3%) and airsoft guns (<1%). Paintball gun injuries had the highest proportion of hospital admissions (12%), followed by pellet guns (8%) and airsoft guns (7%).

"Nonpowder firearms can cause permanent, severe disability and even death," said Dr. Smith. "They are more powerful than many people think and some can achieve a muzzle velocity similar to a handgun. Stricter and more consistent safety legislation at the state level, as well as more child and parental education regarding proper supervision, firearm handling, and use of protective eyewear are needed."

State safety regulations for nonpowder firearms vary greatly, and frequently can be easily circumvented. The variability in regulations includes the age cutoff for child access, with some applying to children younger than 18 years of age and others only to those younger than 12 years of age. There are currently no federal safety regulations for nonpowder firearms, but two voluntary standards have been adopted and manufacturers generally comply with the safety specifications included in these standards.
Data for this study were obtained from the National Electronic Injury Surveillance System (NEISS) database, which is maintained by the US Consumer Product Safety Commission. The NEISS database provides information about consumer product-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of the Abigail Wexner Research Institute at Nationwide Children's Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment, and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit

Nationwide Children's Hospital

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