Department of Surgery & Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Department of Pediatrics, Children's National Hospital, George Washington University, Washington, DC, USA.
Acad Emerg Med. 2021 Aug;28(8):840-847. doi: 10.1111/acem.14318.
Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of nonfatal firearm injuries on utilization and expenditures. Our objective was to compare health care encounters and expenditures 1 year before and 1 year following a nonfatal firearm injury.
This was a retrospective cohort study of children 0 to 18 years with ICD-9/ICD-10 diagnosis codes for firearm injury (excluding nonpowder) in the emergency department or inpatient setting from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included: (1) difference in health care encounters for 1 year before and 1 year after injury, (2) difference in health care expenditures, and (3) difference in complex chronic disease status. Descriptive statistics characterized patient demographics and health care utilization. Health expenditures were evaluated with Wilcoxon signed-rank tests.
Among 1,821 children, there were 22,398 health care encounters before the injury and 28,069 after. Concomitantly, there was an overall increase of $16.5 million in health expenditures ($9,084 per patient). There was a 50% increase in children qualifying for complex chronic condition status after firearm injury.
Children who experience nonfatal firearm injury have increased number of health care encounters, chronic disease classification, and health care expenditures in the year following the injury. Prevention of firearm injuries in this vulnerable age group may result in considerable reductions in morbidity and health care costs.
火器伤是儿童发病率和死亡率的主要可预防原因之一。关于非致命性火器伤对利用和支出的影响，信息有限。我们的目的是比较非致命性火器伤前后 1 年的医疗保健遭遇和支出。
这是一项回顾性队列研究，研究对象为 2010 年至 2016 年期间，在医疗补助市场扫描索赔数据库中，0 至 18 岁的儿童因 ICD-9/ICD-10 诊断代码为火器伤（不包括非火药）而在急诊科或住院治疗。结局包括：（1）受伤前 1 年和受伤后 1 年的医疗保健遭遇差异；（2）医疗保健支出差异；（3）复杂慢性疾病状况差异。描述性统计数据描述了患者的人口统计学和医疗保健利用情况。采用 Wilcoxon 符号秩检验评估医疗支出。
在 1821 名儿童中，受伤前有 22398 次医疗保健遭遇，受伤后有 28069 次。同时，医疗支出总体增加了 1650 万美元（每位患者增加 9084 美元）。有火器伤后符合复杂慢性疾病状况的儿童增加了 50%。
经历非致命性火器伤的儿童在受伤后一年中，医疗保健遭遇、慢性病分类和医疗保健支出增加。预防这一年龄段儿童的火器伤可能会大大降低发病率和医疗保健成本。
