Abramowicz Shelly, Allareddy Veerasathpurush, Rampa Sankeerth, Lee Min Kyeong, Nalliah Romesh P, Allareddy Veerajalandhar
Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; and Associate Chief, Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
Professor, Department of Orthodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA.
J Oral Maxillofac Surg. 2017 Oct;75(10):2170-2176. doi: 10.1016/j.joms.2017.05.035. Epub 2017 Jun 8.
Firearm injuries (FAIs) are a major public health issue in the United States. The objective of this study was to examine characteristics and outcomes of patients presenting to emergency departments (EDs) with facial fractures attributed to FAIs.
The Nationwide Emergency Department Sample for the years 2008 to 2013 was used. All patients who visited EDs with FAIs and facial fractures were selected. The study focused on the following variables: 1) demographic characteristics, 2) types of facial fractures, 3) disposition status after ED visit or subsequent hospitalization, 4) charges (ED and hospitalization), and 5) patient outcomes. The inclusion criteria were a visit to a hospital-based ED with facial fractures and an external cause of FAI. Descriptive statistics were used to summarize findings. Multivariate logistic regression analysis was used to examine the simultaneous effects of patient-related factors on ED death.
During the study period, a total of 15,469 patients (mean age, 34 years) visited hospital-based EDs with facial fractures attributed to FAIs. Most were uninsured male patients. The most common etiology of FAIs was assault. The most common facial fractures were open mandibular fractures and open maxillary and/or malar bone fractures. Approximately 27% of patients had a concomitant intracranial injury. After the ED visit, 74% were admitted. The mean ED charge per patient was $6,403, and the total ED charge across the United States was $76.48 million. The mean hospitalization charge per patient was $167,203. The total hospitalization charge across the United States was $1.9 billion. Patients with intracranial injuries (odds ratio [OR], 21.21; 95% confidence interval [CI], 7.16 to 62.85; P < .01), uninsured patients (OR, 4.24; 95% CI, 1.44 to 12.51; P < .01), and patients residing in areas with high household incomes (OR, 5.60; 95% CI, 2.51 to 12.46; P < .01) were high-risk groups for ED death.
FAIs require substantial resources for stabilization and treatment by EDs. This study highlights the burden and impact of facial fractures in patients with FAIs in the United States.
在美国，火器伤是一个重大的公共卫生问题。本研究的目的是检查因火器伤导致面部骨折而就诊于急诊科（ED）的患者的特征和结局。
使用2008年至2013年的全国急诊科样本。选取所有因火器伤和面部骨折就诊于急诊科的患者。该研究聚焦于以下变量：1）人口统计学特征，2）面部骨折类型，3）急诊科就诊或随后住院后的处置状态，4）费用（急诊科和住院），以及5）患者结局。纳入标准为就诊于医院急诊科且有面部骨折以及火器伤的外部原因。采用描述性统计来总结研究结果。使用多变量逻辑回归分析来检查患者相关因素对急诊科死亡的同时影响。
在研究期间，共有15469例患者（平均年龄34岁）因火器伤导致的面部骨折就诊于医院急诊科。大多数是未参保的男性患者。火器伤最常见的病因是袭击。最常见的面部骨折是开放性下颌骨骨折以及开放性上颌骨和/或颧骨骨折。约27%的患者伴有颅内损伤。急诊科就诊后，74%的患者被收治入院。每位患者的急诊科平均费用为6403美元，美国全国的急诊科总费用为7648万美元。每位患者的住院平均费用为167203美元。美国全国的住院总费用为19亿美元。伴有颅内损伤的患者（比值比[OR]，21.21；95%置信区间[CI]，7.16至62.85；P <.01）、未参保患者（OR，4.24；95%CI，1.44至12.51；P <.01）以及居住在家庭收入高的地区的患者（OR，5.60；95%CI，2.51至12.46；P <.01）是急诊科死亡的高危人群。
火器伤需要急诊科投入大量资源进行稳定病情和治疗。本研究凸显了美国火器伤患者面部骨折的负担和影响。
