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de Oliveira C, Macpherson A, Hepburn CM, Huang A, Strauss R, Liu N, Fiksenbaum L, Pageau P, Gomez D, Saunders NR. Healthcare utilization and costs following non-fatal powdered and non-powdered firearm injuries for children and youth. Eur J Pediatr 2022; 181:2329-2342. [PMID: 35246737 PMCID: PMC9110444 DOI: 10.1007/s00431-022-04429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023]
Abstract
Little is known about the healthcare and economic burdens of non-fatal firearm injuries for children/youth beyond the initial admission. This study sought to estimate healthcare utilization and total direct healthcare costs of non-fatal powdered and non-powdered (air gun) firearm injuries 1-year post-injury. Using administrative data from 2003 to 2018 on all children/youth 0-24 years old in Ontario, Canada, a matched 1:2 cohort study was conducted to compare children/youth who experienced powdered and non-powdered firearm injuries with those who did not. Mean and median number of healthcare encounters and costs, and respective 95% confidence intervals (CIs) and interquartile ranges (IQRs), were estimated for both weapon type groups and controls and by intent. Children/youth who experienced a powdered and non-powdered firearm injury had a higher number of healthcare encounters and costs per year than those who did not. Mean 1-year costs for those with powdered and non-powdered firearm injuries were $8825 ($8007-$9643) and $2349 ($2118-$2578), respectively, versus $812 ($567-$1058) and $753 ($594-$911), respectively, for those without. Mean 1-year costs were highest for handgun injuries ($12,875 [95% CI $9941-$15,808]), and for intentional assault-related ($13,498 [$11,843-$15,153]; $3287 [$2213-$4362]), and intentional self-injuries ($14,773 [$6893-$22,652]; $6005 [$2193-$9817]) for both powdered and non-powdered firearm injuries, respectively. Conclusion: Firearm injuries have substantial healthcare and economic burdens beyond the initial injury-related admission; this should be accounted for when examining the overall impact of firearm injuries. What is Known: • Child/youth firearm injuries have significant health and economic burdens. • However, existing work has mainly examined healthcare utilization and costs of initial admissions and/or have been limited to single-center studies and no studies have provide cost estimates by weapon type and intent. What is New: • Children/youth who suffered powdered firearm injuries had higher mean healthcare utilization and costs than those with non-powdered firearm injuries as well as comparable healthy children/youth. • Mean 1-year costs were highest for handgun injuries ($12,875), and for intentional assault-related ($13,498; $3287), and intentional self-injuries ($14,773; $6005) for powdered and non-powdered firearm injuries, respectively.
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Affiliation(s)
- Claire de Oliveira
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Alison Macpherson
- ICES, Toronto, Canada
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, ON Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Ning Liu
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- The Hospital for Sick Children, Toronto, ON Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - David Gomez
- ICES, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Surgery, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Natasha Ruth Saunders
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, ON Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
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Czaja MP, Kraus CK, Phyo S, Olivieri P, Mederos DR, Puente I, Mohammed S, Berkeley RP, Slattery D, Gildea TH, Hardman C, Palmer B, Whitmill ML, Aluyen U, Pinnow JM, Young A, Eastin CD, Kester NM, Works KR, Pfeffer AN, Keller AW, Tobias A, Li B, Yorkgitis B, Saadat S, Langdorf MI. Injury Characteristics, Outcomes, and Health Care Services Use Associated With Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019. JAMA Netw Open 2022; 5:e2213737. [PMID: 35622366 PMCID: PMC9142871 DOI: 10.1001/jamanetworkopen.2022.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Civilian public mass shootings (CPMSs) in the US result in substantial injuries. However, the types and consequences of these injuries have not been systematically described. OBJECTIVE To describe the injury characteristics, outcomes, and health care burden associated with nonfatal injuries sustained during CPMSs and to better understand the consequences to patients, hospitals, and society at large. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series of nonfatal injuries from 13 consecutive CPMSs (defined as ≥10 injured individuals) from 31 hospitals in the US from July 20, 2012, to August 31, 2019, used data from trauma logs and medical records to capture injuries, procedures, lengths of stay, functional impairment, disposition, and charges. A total of 403 individuals treated in hospitals within 24 hours of the CPMSs were included in the analysis. Data were analyzed from October 27 to December 5, 2021. EXPOSURES Nonfatal injuries sustained during CPMSs. MAIN OUTCOMES AND MEASURES Injuries and diagnoses, treating services, procedures, hospital care, and monetary charges. RESULTS Among the 403 individuals included in the study, the median age was 33.0 (IQR, 24.5-48.0 [range, 1 to >89]) years, and 209 (51.9%) were women. Among the 386 patients with race and ethnicity data available, 13 (3.4%) were Asian; 44 (11.4%), Black or African American; 59 (15.3), Hispanic/Latinx; and 270 (69.9%), White. Injuries included 252 gunshot wounds (62.5%) and 112 other injuries (27.8%), and 39 patients (9.7%) had no physical injuries. One hundred seventy-eight individuals (53.1%) arrived by ambulance. Of 494 body regions injured (mean [SD], 1.35 [0.68] per patient), most common included an extremity (282 [57.1%]), abdomen and/or pelvis (66 [13.4%]), head and/or neck (65 [13.2%]), and chest (50 [10.1%]). Overall, 147 individuals (36.5%) were admitted to a hospital, 95 (23.6%) underwent 1 surgical procedure, and 42 (10.4%) underwent multiple procedures (1.82 per patient). Among the 252 patients with gunshot wounds, the most common initial procedures were general and trauma surgery (41 [16.3%]) and orthopedic surgery (36 [14.3%]). In the emergency department, 148 of 364 injured individuals (40.7%) had 199 procedures (1.34 per patient). Median hospital length of stay was 4.0 (IQR, 2.0-7.5) days; for 50 patients in the intensive care unit, 3.0 (IQR, 2.0-8.0) days (13.7% of injuries and 34.0% of admissions). Among 364 injured patients, 160 (44.0%) had functional disability at discharge, with 19 (13.3%) sent to long-term care. The mean (SD) charges per patient were $64 976 ($160 083). CONCLUSIONS AND RELEVANCE Civilian public mass shootings cause substantial morbidity. For every death, 5.8 individuals are injured. These results suggest that including nonfatal injuries in the overall burden of CPMSs may help inform public policy to prevent and mitigate the harm caused by such events.
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Affiliation(s)
- Matthew P. Czaja
- Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico
| | | | - Su Phyo
- Touro University Nevada College of Osteopathic Medicine, Henderson
| | | | - Dalier R. Mederos
- Division of Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, Florida
| | - Ivan Puente
- Division of Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, Florida
| | - Salman Mohammed
- Department of Emergency Medicine, University of Nevada, Las Vegas Kirk Kerkorian School of Medicine, Las Vegas
| | - Ross P. Berkeley
- Department of Emergency Medicine, University of Nevada, Las Vegas Kirk Kerkorian School of Medicine, Las Vegas
| | - David Slattery
- Department of Emergency Medicine, University of Nevada, Las Vegas Kirk Kerkorian School of Medicine, Las Vegas
| | - Thomas H. Gildea
- Department of Emergency Medicine, St Louise Regional Hospital, Gilroy, California
- Department of Emergency Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Claire Hardman
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Brandi Palmer
- Trauma Research Program, Kettering Medical Center, Kettering, Ohio
| | - Melissa L. Whitmill
- Division of Acute Care Surgery, Critical Care, and Trauma, Department of Surgery, Kettering Medical Center, Kettering, Ohio
| | - Una Aluyen
- Department of Emergency Medicine, Texas Tech University Health Sciences Center School of Medicine, Odessa
| | - Jeffery M. Pinnow
- Department of Emergency Medicine, Medical Center Hospital, Odessa, Texas
| | - Amanda Young
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Carly D. Eastin
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Nurani M. Kester
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio
| | - Kaitlyn R. Works
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew N. Pfeffer
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aleksander W. Keller
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Adam Tobias
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Benjamin Li
- Department of Emergency Medicine, Denver Health, Denver, Colorado
| | - Brian Yorkgitis
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Jacksonville
| | - Soheil Saadat
- Department of Emergency Medicine, School of Medicine, University of California, Irvine
| | - Mark I. Langdorf
- Department of Emergency Medicine, School of Medicine, University of California, Irvine
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Upper extremity firearm injuries: epidemiology and factors predicting hospital admission. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1173-1178. [PMID: 35486233 DOI: 10.1007/s00590-022-03258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Civilian gun violence is a public health crisis in the USA that will be an economic burden reported to be as high as $17.7 billion with over half coming from US taxpayers dollars through Medicaid-related costs. The purpose of this study is to review the epidemiology of upper extremity firearm injuries in the USA and the associated injury burden. METHODS The Inter-university Consortium for Political and Social Research's Firearm Injury Surveillance Study database, collected from the National Electronic Injury Surveillance System, was queried from 1993 to 2015. The following variables were reviewed: patient demographics, date of injury, diagnosis, injury location, firearm type (if provided), incident classification, and a descriptive narrative of the incident. We performed chi-square testing and complex descriptive statistics, and binomial logistic regression model to predict factors associated with hospital admission. RESULTS From 1993 to 2015, an estimated 314,369 (95% CI: 291,528-337,750; 16,883 unweighted) nonfatal firearm upper extremity injuries with an average incidence rate of 4.76 per 100,000 persons (SD: 0.9; 03.77-7.49) occurred. The demographics most afflicted with nonfatal gunshot wound injuries were black adolescent and young adult males (ages 15-24 years). Young adults aged 25-34 were the second largest estimate of injuries by age group. Hands were the most commonly injured upper extremity, (55,014; 95% CI: 75,973-89,667) followed by the shoulder, forearm, and upper arm. Patients who underwent amputation (OR: 28.65; 95% CI: 24.85-33.03) or with fractures (OR: 26.20; 95% CI: 23.27-29.50) experienced an increased likelihood for hospitalization. Patients with a shoulder injury were 5.5× more likely to be hospitalized than those with a finger injury (OR:5.57; 95% CI:5.35-5.80). The incidence of upper extremity firearm injuries has remained steady over the last decade ranging between 4 and 5 injuries per 100,000 persons. Patients with proximal injuries or injuries involving the bone were more likely to require hospital admission. This study should bring new information to the forefront for policy makers regarding gun violence.
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Schnippel K, Burd-Sharps S, Miller TR, Lawrence BA, Swedler DI. Nonfatal Firearm Injuries by Intent in the United States: 2016-2018 Hospital Discharge Records from the Healthcare Cost and Utilization Project. West J Emerg Med 2021; 22:462-470. [PMID: 34125015 PMCID: PMC8203029 DOI: 10.5811/westjem.2021.3.51925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In addition to the nearly 40,000 firearm deaths each year, nonfatal firearm injuries represent a significant public health burden to communities in the United States. We aimed to describe the incidence and rates of nonfatal firearm injuries. METHODS We calculated nonfatal firearm injury estimates using the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, including the Nationwide Emergency Department Samples and the National Inpatient Samples. We used the International Classification of Diseases, 10th Revision, Clinical Modification to identify firearm injury episodes. Deaths in the emergency department (ED) or as inpatients were excluded. RESULTS In addition to the 118,171 persons shot and killed by firearms from 2016-2018, 228,380 people were shot (ratio 1.9:1) and treated at a hospital ED or admitted to hospital, a rate of 23.4 nonfatal firearm injury episodes per 100,000 population. The number of nonfatal injury episodes varied by year: 2018 had the lowest at 69,692, compared to 84,776 in 2017 and 73,912 in 2016. Unintentional injury episodes were the most frequent, accounting for 58.5% (n = 81,217) and 38.9% (n = 34,820) of total nonfatal firearm hospital discharges from the ED and inpatients, respectively. Assault episodes were the next most frequent, at 36.3% (n = 50,482) of ED and 49.5% (n = 44,290) of inpatient discharges. The highest rate of nonfatal firearm injury by five-year age group was for 20- to 24-year-olds. With an annual rate of 73.53 per 100,000 population, the rates for ages 20-24 were more than 10 times higher than the rates for patients younger than 15 or 60 years and older. More than half (53.4%, n = 121,884) of hospital-treated, nonfatal firearm injury episodes were patients living in ZIP codes with a median household income in the lowest quartile, compared to 7.5% (n = 17,102) for patients residing in the highest income quartile ZIP codes, a sevenfold difference. CONCLUSION For every person shot and killed by a gun in the US, two more are wounded. Unlike firearm deaths, which are predominantly suicides, most nonfatal firearm injury episodes are unintentional or with an assault intent. Having a reliable source of nonfatal injury data is essential to understanding the incidence of firearm injuries.
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Affiliation(s)
| | | | - Ted R. Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | | | - David I. Swedler
- Pacific Institute for Research and Evaluation, Calverton, Maryland
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