Vanderbilt University Medical Center, Department of Surgery, Nashville, TN.
Vanderbilt University Medical Center, Department of Orthopedic Surgery, Nashville, TN.
J Pediatr Surg. 2020 Sep;55(9):1754-1760. doi: 10.1016/j.jpedsurg.2019.09.030. Epub 2019 Oct 27.
Musculoskeletal pediatric firearm injuries are a clinically significant and expensive public health problem in the United States. In this retrospective cohort analysis, we sought to characterize musculoskeletal firearm injuries in children and to describe the financial burden associated with these injuries.
This study is a single center, retrospective review. Patients were identified from January 2002 - December 2015 from an institutional database using ICD-9 codes pertaining to firearm injury. Inclusion criteria were: 1) age < 18 years at injury; 2) firearm injury to an extremity, spine, or pelvis; and 3) patient received orthopedic evaluation and/or treatment. 140 patients with 142 distinct orthopedic injuries meeting inclusion criteria were analyzed (N = 142). Primary measures were demographic and situational data including intent, length of stay, follow-up, and complications; and financial outcomes including charges, costs, and net revenues.
Median age was 15.3 years [IQR: 13.3, 16.4], 84% were male, and 52% were African American. 59% of the firearm injuries were of violent intent. 32% of patients were privately insured, 61% were publicly insured, and 6% were uninsured. Median length of stay was 2 days [0, 4], with 73% of patients being admitted. 43% of patients required additional hospitalizations, emergency room visits, and/or outpatient surgeries, and 93% of patients had outpatient follow-up. 42% of patients experience an injury-related or long-term orthopedic complication. Total charges for the cohort were $11.4 million, with $3.7 million in costs and $45,042 in net revenues. In the multivariable analysis, more surgeries predicted higher charges, and more secondary encounters predicted higher costs and net revenues. Only privately-insured patients had a positive median net revenue.
Children who sustain musculoskeletal injuries from firearms experience high rates of orthopedic complications. Institutional costs to manage these preventable injuries are excessive. Policy makers should continue to pursue measures to reduce gun violence and improve gun safety in the pediatric population.
Level III, economic/decision.
在美国，肌肉骨骼儿科火器伤是一个具有临床意义且代价高昂的公共卫生问题。在这项回顾性队列分析中，我们旨在描述儿童肌肉骨骼火器伤的特征，并描述与这些损伤相关的经济负担。
本研究为单中心回顾性研究。使用与火器伤相关的 ICD-9 代码，从 2002 年 1 月至 2015 年 12 月从机构数据库中确定患者。纳入标准为：1）受伤时年龄<18 岁；2）四肢、脊柱或骨盆火器伤；3）患者接受骨科评估和/或治疗。分析了符合纳入标准的 142 例不同骨科损伤的 140 例患者（N=142）。主要指标包括人口统计学和情境数据，包括意图、住院时间、随访和并发症；以及财务结果，包括费用、成本和净收入。
中位年龄为 15.3 岁[IQR：13.3，16.4]，84%为男性，52%为非裔美国人。59%的火器伤是暴力所致。32%的患者有私人保险，61%有公共保险，6%没有保险。中位住院时间为 2 天[0，4]，73%的患者住院。43%的患者需要额外的住院、急诊就诊和/或门诊手术，93%的患者有门诊随访。42%的患者出现与损伤相关或长期骨科并发症。该队列的总费用为 1140 万美元，其中 3700 万美元为成本，45042 美元为净收入。在多变量分析中，更多的手术预示着更高的费用，更多的二次就诊预示着更高的成本和净收入。只有私人保险的患者有正的中位净收入。
儿童因枪支受伤导致肌肉骨骼损伤的发生率很高，这些可预防损伤的机构管理成本过高。政策制定者应继续采取措施减少儿童枪支暴力事件并提高儿童枪支安全性。
三级，经济/决策。
