Civilian gunshot wounds--outpatient management

Cost containment is important in this time of inner-city economic and health-care crisis. Of 28,150 patients treated for gunshot wounds (GSWs) from 1977 through 1991, 16,892 (60%) were treated as outpatients after emergency department evaluation and treatment. The complication rate was 1.8% (mostly infections), and nine patients were later found to have vascular injuries requiring surgical treatment. These were identified later at outpatient follow-up and treated with no long-term morbidity or mortality. A conservative estimate of the cost savings from this study was more than $37 million. With a more liberal use of angiography to eliminate rare missed vascular injuries, many GSW victims can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.