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Firearm Injuries: Unveiling the Unmatched Healthcare Burden and Costs
Colleen P Nofi1,2,3, Emma Cornell4, Bailey K Roberts1,2,3
1From the Department of Surgery, Northwell - North Shore/Long Island Jewish Medical Center, Manhasset, NY.
Insights
Firearm injuries demand more hospital resources, including interventions and higher costs, compared to other trauma types. This underscores the need for targeted prevention and resource allocation for firearm trauma care.
Area of Science:
- Trauma Care and Public Health
- Health Services Research
- Injury Epidemiology
Background:
- Firearm injuries are a significant cause of death, particularly among children, yet their inpatient healthcare burden is not well understood.
- Trauma remains a leading cause of morbidity and mortality in the U.S.
Purpose of the Study:
- To compare hospital resource utilization for firearm-related injuries versus other penetrating and blunt traumas.
- To analyze costs, length of stay, and mortality associated with different trauma types.
Main Methods:
- Retrospective cohort study utilizing the National Inpatient Sample (2017-2021).
- Inclusion of patients with firearm, penetrating, and blunt trauma injuries.
- Assessment of surgical interventions, hospital costs, length of stay, and mortality rates.
Main Results:
- Firearm injuries necessitated more complex surgical interventions and had longer inpatient stays (7.8 days) than penetrating (5.7 days) or blunt trauma (6.0 days).
- Inpatient mortality was significantly higher for firearm injuries (6.5%) compared to penetrating (0.6%) and blunt trauma (2.8%).
- Total hospital costs were substantially greater for firearm injuries ($30,529) versus penetrating ($12,243) and blunt trauma ($18,333).
Conclusions:
- Firearm injuries, despite lower overall incidence, drive disproportionately high inpatient resource utilization and costs.
- Findings emphasize the critical need for focused prevention strategies and optimized resource allocation for firearm trauma.
- Addressing the unique challenges of firearm injuries is essential for improving trauma care outcomes and managing healthcare expenditures.
Objective:
This study aimed to evaluate hospital resource utilization in the treatment of firearm-related injuries compared to other penetrating and blunt traumas.
Background:
Trauma is a leading cause of morbidity and mortality in the United States, with firearm injuries becoming the leading cause of pediatric death as of 2020. Despite the known mortality, the burden of inpatient healthcare for initially nonfatal firearm injuries is poorly understood.
Methods:
A retrospective cohort study of the National Inpatient Sample was performed. The study population included patients with firearm injuries, penetrating traumas, and blunt traumas from 2017 to 2021. Primary interventions assessed included surgical procedures performed during hospitalization, and the outcomes evaluated were costs, length of stay, and mortality. Comparisons were made between the 3 injury groups (firearm, penetrating trauma, and blunt trauma) across these key variables.
Results:
Among 10,653,446 patients identified, 243,295 (2.3%) had a firearm injury, 287,110 (2.7%) had a penetrating injury, and 10,123,041 (95%) had blunt trauma. Patients sustaining firearm injuries required more resuscitative interventions and major surgical procedures, such as pericardiotomy, chest tube placement, exploratory thoracotomy, and laparotomy. The mean length of inpatient stay was longer for firearm injuries (7.8 days) compared with penetrating (5.7 days) and blunt trauma (6.0 days, P < 0.001). Inpatient death rates were higher for firearm injuries (6.5%) compared with penetrating (0.6%) and blunt trauma (2.8%, P < 0.001). Total hospital costs were higher for firearm injuries ($30,529) compared with penetrating ($12,243) and blunt trauma ($18,333, P < 0.001). Firearm injuries remained a significant predictor of higher hospital costs, even after adjusting for other factors (adjusted incidence rate ratio 1.256; P < 0.001).
Conclusions:
Although firearm injuries account for only a proportion of total trauma cases, they are associated with higher inpatient resource utilization, as measured by interventions and hospital costs. These findings highlight the need for focused prevention efforts and resource allocation to address unique challenges posed by firearm injuries.
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