Department of Pediatric Critical Care, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Global Health, Harvard School of Dental Medicine, Boston, Massachusetts.
JAMA Otolaryngol Head Neck Surg. 2014 Apr;140(4):303-11. doi: 10.1001/jamaoto.2014.61.
Firearm injuries (FAIs) play a major role in unintentional injuries, suicides, and homicides. It is important that policy makers, public health authorities, physicians, and the public are kept abreast of current trends in FAIs so that preventive programs can be tailored to the needs of cohorts that are at highest risk for such injuries.
To provide nationally representative longitudinal estimates of outcomes associated with hospitalizations attributed to FAIs in all age groups in the United States during the years 2003 to 2010; to obtain prevalence estimates of skull and/or facial fractures and intracranial injuries among those hospitalized owing to firearm injuries; and to examine the association between the occurrence of skull and/or facial fractures and/or intracranial injuries and in-hospital mortality.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective analysis of the largest all-payer hospitalization data set in the United States, we evaluate a Nationwide Inpatient Sample of patients hospitalized for FAIs during the years 2003 to 2010.
Face and/or skull fracture and/or intracranial injuries due to firearm injuries.
The main outcome of interest was in-hospital mortality. The primary independent variables included occurrence of face and/or skull fracture and/or intracranial injuries. RESULTS During the study period, 252,181 visits were attributed to FAIs. Adolescents and young adults accounted for nearly 80% of all hospitalizations, with more than half of these in the 18- to 29-year-old, high-risk group. Male patients consistently accounted for 89% of the hospitalizations. The uninsured population accounted for nearly a third of hospitalizations. A total of 214,221 FAI hospitalizations did not involve facial and/or skull fractures or intracranial injuries; 13,090 involved a facial and/or skull fracture without a concomitant intracranial injury; 20,453 involved an intracranial injury without a concomitant facial and/or skull fracture; and 4417 involved both a facial and/or skull fracture and intracranial injury. Those with intracranial injuries without concomitant facial and/or skull fractures (odds ratio [OR], 58.40; 95% CI, 50.08-68.11) (P < .001) and those with both facial and/or skull fractures and intracranial injuries (OR, 17.45; 95% CI, 13.98-21.79) (P < .001) were associated with higher odds of in-hospital mortality than those without these injuries. Teaching hospitals were associated with higher odds of in-hospital mortality than nonteaching hospitals (OR, 1.31; 95% CI, 1.14-1.49) (P < .001). Teaching hospitals also tended to treat a higher proportion of complex cases. The uninsured had higher odds of in-hospital mortality than those with private insurance (OR, 1.55; 95% CI, 1.35-1.78).
AND RELEVANCE Occurrence of intracranial injuries was an independent risk factor for poor outcomes. Teaching hospitals had higher mortality rates but also treated more complex cases than nonteaching hospitals.
枪支伤害（FAI）在意外伤害、自杀和凶杀中起着重要作用。政策制定者、公共卫生当局、医生和公众了解 FAI 当前趋势非常重要，以便可以根据最容易受到此类伤害的人群的需要制定预防计划。
提供美国所有年龄段人群因枪支伤害住院的相关结局的全国代表性纵向估计值；获得因枪支伤害住院患者的颅骨和/或面部骨折和颅内损伤的患病率估计值；并研究颅骨和/或面部骨折和/或颅内损伤与院内死亡率之间的关系。
设计、设置和参与者：在这项对美国最大的全支付住院数据集中的回顾性分析中，我们评估了 2003 年至 2010 年期间因枪支伤害住院的全国住院患者样本。
因枪支伤害导致的面部和/或颅骨骨折和/或颅内损伤。
主要结局是院内死亡率。主要的独立变量包括面部和/或颅骨骨折和/或颅内损伤的发生。结果：在研究期间，共有 252181 次就诊归因于 FAI。青少年和年轻人占所有住院患者的近 80%，其中一半以上是 18 至 29 岁的高风险人群。男性患者始终占住院患者的 89%。无保险人群占住院患者的近三分之一。共有 214221 例 FAI 住院患者未涉及面部和/或颅骨骨折或颅内损伤；13090 例涉及面部和/或颅骨骨折而无伴随颅内损伤；20453 例涉及颅内损伤而无伴随面部和/或颅骨骨折；4417 例涉及面部和/或颅骨骨折和颅内损伤。那些没有面部和/或颅骨骨折但有颅内损伤的患者（比值比 [OR]，58.40；95%CI，50.08-68.11）（P<0.001）和那些既有面部和/或颅骨骨折又有颅内损伤的患者（OR，17.45；95%CI，13.98-21.79）（P<0.001）与更高的院内死亡率相关。教学医院与非教学医院相比，院内死亡率的比值比更高（OR，1.31；95%CI，1.14-1.49）（P<0.001）。教学医院也倾向于治疗更复杂的病例。无保险患者的院内死亡率高于有私人保险的患者（OR，1.55；95%CI，1.35-1.78）。
颅内损伤的发生是预后不良的独立危险因素。教学医院的死亡率较高，但治疗的复杂病例也比非教学医院多。
