Barely Benign: Pediatric Nonpowder Firearm Injury

Infographic · Mar 2020 · 2 min read

In brief

Retrospective study of 46 children treated for nonpowder gun injuries reveals that 39% sustained severe penetrating injuries to organs or body cavities, with 37% requiring surgery. Despite being marketed as toys, BB and pellet guns caused significant trauma including intracranial hemorrhage and solid organ lacerations, warranting full penetrating trauma workup.

NPGs cause 22,000 pediatric ED visits annually; 39% penetrate organs/cavities despite 'low-velocity' perception
Common serious injuries: subarachnoid hemorrhage, lung/liver/kidney lacerations, pulmonary artery and tracheal injuries
37% of NPG-injured children required surgery; 9% needed ICU admission—treat as penetrating trauma, not superficial injury
Head/neck (28%), anterior torso (26%), and eye (24%) most commonly injured; 85% of injuries were penetrating
Standard collateral damage absent—serious NPG injuries easily overlooked; always perform thorough penetrating trauma workup

Written by the GCMD Library team from the infographic.

Blue-themed infographic with white text and icons. Left side shows patient demographics with male symbol and pie chart. Center displays body diagram with injury location percentages. Right side presents outcome statistics with icons for operating room, home, hospital, and ICU. Bottom includes journal citation and author headshot.

Nonpowder guns (NPGs), such as ball-bearing (BB), pellet, paintball, or airsoft guns, use compressed air to launch a projectile. Between 2001 and 2011, more than 145,000 children less than 19 years old were injured by NPGs in the United States, and nearly 22,000 NPG-related injuries are treated in pediatric emergency departments each year. Treatment for children with NPG injuries varies depending on the injury's severity, often including computed tomography scans, bedside procedures, angiography, and operative intervention. Since most NPGs fire ‘low-velocity’ projectiles, and perhaps since these guns are often labeled as toys, it is commonly believed that they can result in only superficial, minor injuries. Serious injuries may be overlooked owing to the lack of standard collateral damage seen with ‘traditional’ gunshot injuries. The purpose of this study is to review the types of injuries and outcomes from NPGs in a large pediatric cohort in order to better understand the risk profile.

Methods

We conducted a retrospective review of children ≤18 years of age treated for nonpowder gun injuries at a pediatric level I trauma center during 2013–2017. Demographics, injury characteristics, treatments, and outcomes were reviewed and analyzed using descriptive statistics.

Results

Forty-six cases were identified; of these, 78% were male and the median age was 10 years (IQR 7–13). All guns were either ball-bearing or pellet guns. Eighty-five percent (38/46) of injuries were penetrating. The most common location was the head and neck (28%), followed by the anterior torso (26%) and eye (24%). Significant injuries that penetrated organs or body cavities occurred in 39% (18/46) and included subarachnoid hemorrhage; lung, liver, and kidney lacerations; pulmonary artery injury; and tracheal injury. Nine percent (4/26) were admitted to the intensive care unit, 37% (17/46) underwent surgery, and there were no deaths.

Discussion

Injuries from recreational nonpowder guns such as ball-bearing or pellet guns can cause severe injuries in children. A thorough penetrating trauma workup should always be undertaken. Safety precautions should be taken when using these guns and access to young children should be restricted.