Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center (LAC+USC), Los Angeles, CA.
Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center (LAC+USC), Los Angeles, CA.
J Am Coll Surg. 2019 Aug;229(2):141-149. doi: 10.1016/j.jamcollsurg.2019.02.048. Epub 2019 Mar 13.
Gunshot wound (GSW) injuries present a unique surgical challenge. This study explored the financial and clinical burdens of GSW patients across 2 Los Angeles County Level I trauma centers over the last 12 years, and compared them with other forms of interpersonal injury (OIPI).
This was a retrospective study of patients presenting as those with GSW and OIPI (defined as combined stab wound or blunt assault), between January 1, 2006 and March 30, 2018, at LAC+USC Medical Center (LAC+USC) and Harbor UCLA Medical Center (HUCLA). Demographic and clinical variables were assessed for GSW patients and compared with victims of OIPI.
There were 17,871 patients who met inclusion criteria. There was a significant difference in mortality for patients with GSW vs OIPI (11% vs 2%, p < 0.001). The odds ratio for GSW patients requiring operation was twice as high as those suffering OIPI (odds ratio [OR] 2.0, 95% CI 1.8 to 2.2). The odds ratio for GSW patients requiring ICU admission was 20% higher than that for OIPI patients (OR 1.23, 95% CI 1.11 to 1.36). Gunshot wound patients experienced a longer median length of stay vs OIPI patients (3 days vs 2 days, p < 0.001). The median hospital charge per admission for GSW was twice that of OIPI (GSW $12,612 vs OIPI $6,195; p < 0.001).
When compared with OIPI, GSW patients arrived more severely injured and required more operations, more ICU admissions, and longer hospital stays. Patients with GSW incurred significantly higher hospital charges and had a significantly higher mortality rate. Gunshot wound injury is a unique public health concern requiring comprehensive, nation-wide, contemporary study.
枪伤（GSW）带来了独特的外科挑战。本研究在过去 12 年中探索了洛杉矶县 2 家一级创伤中心的 GSW 患者的财务和临床负担，并将其与其他形式的人际伤害（OIPI）进行了比较。
这是一项回顾性研究，纳入了 2006 年 1 月 1 日至 2018 年 3 月 30 日期间在洛杉矶加大医疗中心（LAC+USC）和 Harbor UCLA 医疗中心（HUCLA）就诊的 GSW 和 OIPI（定义为联合刺伤或钝器袭击）患者。评估了 GSW 患者的人口统计学和临床变量，并与 OIPI 患者进行了比较。
共有 17871 名符合纳入标准的患者。与 OIPI 患者相比，GSW 患者的死亡率存在显著差异（11% vs 2%，p < 0.001）。需要手术的 GSW 患者的优势比是 OIPI 患者的两倍（优势比[OR] 2.0，95%CI 1.8 至 2.2）。需要入住 ICU 的 GSW 患者的优势比比 OIPI 患者高 20%（OR 1.23，95%CI 1.11 至 1.36）。与 OIPI 患者相比，GSW 患者的中位住院时间更长（3 天 vs 2 天，p < 0.001）。每例住院的平均医疗费用，GSW 是 OIPI 的两倍（GSW $12612 与 OIPI $6195；p < 0.001）。
与 OIPI 相比，GSW 患者受伤更严重，需要更多的手术、更多的 ICU 入院和更长的住院时间。GSW 患者的住院费用显著更高，死亡率也显著更高。枪伤是一个独特的公共卫生问题，需要进行全面、全国性的现代研究。
