Sir,
Paintballs pose a significant risk for devastating ocular trauma.1 ASTM International2 regularly publishes eye protection standards for paintball, and guidelines from the National Professional Paintball League3 in the United States require that players exposed to shooting areas wear eye protection that meets these standards. ASTM International has updated their standards four times since 1999, most recently in 2012. To assess the impact of these guidelines, this study investigated the patterns of ocular paintball trauma that presented to US emergency departments (EDs) from 2001 to 2010.
The study received Institutional Review Board exemption from Rhode Island Hospital. Data were extracted from the National Electronic Injury Surveillance System (NEISS-CPSC) and reviewed for demographics, diagnosis, locale, and eye protection status.4 Patients were included if they visited an ED from 2001 to 2010 with an injury that (1) involved paintball equipment and (2) affected the eye. Weighted estimates were calculated using SAS version 9.1.2 (SAS Institute, Inc., Cary, NC, USA).
All statistical estimates represent weighted frequencies based on data from 100 representative US EDs. Of 11 827 paintball-related eye injuries from 2001 to 2010 (Table 1), most occurred in patients who were male (10 906; 92.2%) and aged 10–19 years (8055; 68.1%). The highest proportion of injuries occurred from 2001 to 2004 (13.7–15.2%). Of 1586 patients with eye protection data, 724 (45.6%) removed protection immediately before injury and 863 (54.4%) were not wearing protection.
Table 1. Demographics and characteristics of patients with ocular paintball trauma in the United States from 2001 to 2010.
| Characteristic | Actual frequency; n=333 | National estimates (95% confidence interval); n=11 827a | Percentage of patients with ocular paintball injury |
|---|---|---|---|
| Gender | |||
| Male | 302 | 10 906 (9837–11 976) | 92.2 |
| Female | 31 | 921 (490–1352)b | 7.8 |
| Age | |||
| 0–9 years | 22 | 453 (156–750)b | 3.8 |
| 10–19 years | 228 | 8055 (7007–9102) | 68.1 |
| 20–29 years | 51 | 2138 (1464–2813) | 18.1 |
| ≥30 years | 32 | 1181 (675–1688)b | 10.0 |
| Race | |||
| White | 177 | 6947 (5892–8001) | 58.7 |
| Black/African American | 27 | 665 (328–1003)b | 5.6 |
| Unknown | 97 | 3295 (2510–4080) | 27.9 |
| Other | 32 | 920 (497–1343)b | 7.8 |
| Coded diagnosis | |||
| Contusions, abrasions | 163 | 6081 (1074–7089) | 51.4 |
| Dermatitis, conjunctivitis | 4 | 100 (0–229)b | 0.8 |
| Foreign body | 6 | 208 (0–442)b | 1.8 |
| Hematoma | 6 | 214 (0–428)b | 1.8 |
| Hemorrhage | 18 | 360 (104–616)b | 3.0 |
| Internal injury | 1 | 60 (0–180)b | 0.5 |
| Laceration | 7 | 306 (30–582)b | 2.6 |
| Nerve damage | 2 | 31 (0–73)b | 0.3 |
| Puncture | 4 | 179 (0–400)b | 1.5 |
| Strain or sprain | 2 | 85 (0–223)b | 0.7 |
| Other/not stated | 120 | 4203 (3351–5055) | 35.5 |
| Locale | |||
| Home | 84 | 3262 (2451–4074) | 27.6 |
| Public property | 17 | 596 (222–970)b | 5.0 |
| Recreation/sports venue | 54 | 2635 (1872–3398) | 22.3 |
| Street/highway | 2 | 22 (0–54)b | 0.2 |
| Not recorded | 176 | 5312 (4415–6210) | 44.9 |
| Year of injury | |||
| 2001 | 41 | 1802 (1386–2218) | 15.2 |
| 2002 | 40 | 1649 (1281–2016) | 13.9 |
| 2003 | 50 | 1625 (1228–2021) | 13.7 |
| 2004 | 49 | 1802 (1379–2225) | 15.2 |
| 2005 | 40 | 1152 (810–1493)b | 9.7 |
| 2006 | 40 | 1344 (960–1728) | 11.4 |
| 2007 | 18 | 680 (404–956)b | 5.7 |
| 2008 | 14 | 519 (263–776)b | 4.4 |
| 2009 | 25 | 918 (640–1196)b | 7.8 |
| 2010 | 16 | 336 (148–523)b | 2.8 |
Weighted frequencies based on 100 representative emergency departments in the National Electronic Injury Surveillance System.
Estimates with frequencies <20, weighted frequencies <1200, and/or coefficient of variation >0.3 may not be statistically stable based on guidelines from the National Electronic Injury Surveillance System.
This study found that ocular paintball injuries are decreasing over time but – despite clearly defined eye protection guidelines – remain a persistent challenge, especially in males and young patients. Several injuries were related to removing or not using eye protection. Moreover, similar proportions of injuries occurred at home and in commercial settings. This suggests the need for further enforcement of eye protection protocols, regardless of locale.
The interpretation of the type and severity of injuries was limited by minimal ocular code-based data within NEISS-CPSC.4 In addition, the NEISS-CPSC did not include cases that presented outside of EDs.
In conclusion, additional strategies are needed to reduce the incidence of preventable paintball injuries, including placing age or licensure limitations on paintball equipment sales and better enforcement of eye protection requirements.
The authors declare no conflict of interest.
References
- Alliman KJ, Smiddy WE, Banta J, Qureshi Y, Miller DM, Schiffman JC. Ocular trauma and visual outcome secondary to paintball projectiles. Am J Ophthalmol. 2009;147:239–242. doi: 10.1016/j.ajo.2008.08.007. [DOI] [PubMed] [Google Scholar]
- ASTM International ASTM Standard F1776-10, “Standard Specification for Eye Protective Devices for Paintball Sports” ASTM International: West Conshohocken, PA, USA; 2010. doi: 10.1520/F1776-10, , www.astm.org . [Google Scholar]
- National Professional Paintball League. Official Rule Book. 2012. Available at: : http://nppl.com/wp-content/uploads/2013/03/NPPLRulebook2012.pdf . Accessed 15 December 2013.
- US Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS) On-Line. 2013. Available at: : http://www.cpsc.gov/en/Research—Statistics/NEISS-Injury-Data/ . Accessed 30 June 2013.