Nofi Colleen P, Cornell Emma, Roberts Bailey K, Klein-Cloud Rafael, Chandereng Thevaa, Sondhi Arjun, Chiuzan Codruta, Sathya Chethan
From the Department of Surgery, Northwell - North Shore/Long Island Jewish Medical Center, Manhasset, NY.
Division of Pediatric Surgery, Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY.
Ann Surg Open. 2025 Jun 24;6(3):e590. doi: 10.1097/AS9.0000000000000590. eCollection 2025 Sep.
This study aimed to evaluate hospital resource utilization in the treatment of firearm-related injuries compared to other penetrating and blunt traumas.
Trauma is a leading cause of morbidity and mortality in the United States, with firearm injuries becoming the leading cause of pediatric death as of 2020. Despite the known mortality, the burden of inpatient healthcare for initially nonfatal firearm injuries is poorly understood.
A retrospective cohort study of the National Inpatient Sample was performed. The study population included patients with firearm injuries, penetrating traumas, and blunt traumas from 2017 to 2021. Primary interventions assessed included surgical procedures performed during hospitalization, and the outcomes evaluated were costs, length of stay, and mortality. Comparisons were made between the 3 injury groups (firearm, penetrating trauma, and blunt trauma) across these key variables.
Among 10,653,446 patients identified, 243,295 (2.3%) had a firearm injury, 287,110 (2.7%) had a penetrating injury, and 10,123,041 (95%) had blunt trauma. Patients sustaining firearm injuries required more resuscitative interventions and major surgical procedures, such as pericardiotomy, chest tube placement, exploratory thoracotomy, and laparotomy. The mean length of inpatient stay was longer for firearm injuries (7.8 days) compared with penetrating (5.7 days) and blunt trauma (6.0 days, < 0.001). Inpatient death rates were higher for firearm injuries (6.5%) compared with penetrating (0.6%) and blunt trauma (2.8%, < 0.001). Total hospital costs were higher for firearm injuries ($30,529) compared with penetrating ($12,243) and blunt trauma ($18,333, < 0.001). Firearm injuries remained a significant predictor of higher hospital costs, even after adjusting for other factors (adjusted incidence rate ratio 1.256; < 0.001).
Although firearm injuries account for only a proportion of total trauma cases, they are associated with higher inpatient resource utilization, as measured by interventions and hospital costs. These findings highlight the need for focused prevention efforts and resource allocation to address unique challenges posed by firearm injuries.
本研究旨在评估与其他穿透性和钝性创伤相比，治疗火器相关损伤时医院资源的利用情况。
创伤是美国发病和死亡的主要原因，截至2020年，火器伤已成为儿童死亡的主要原因。尽管已知死亡率，但对于最初非致命火器伤的住院医疗负担了解甚少。
对国家住院样本进行回顾性队列研究。研究人群包括2017年至2021年期间遭受火器伤、穿透性创伤和钝性创伤的患者。评估的主要干预措施包括住院期间进行的外科手术，评估的结局指标为费用、住院时间和死亡率。对这三个损伤组（火器伤、穿透性创伤和钝性创伤）在这些关键变量上进行比较。
在10653446名被识别的患者中，243295名（2.3%）有火器伤，287110名（2.7%）有穿透性损伤，10123041名（95%）有钝性创伤。遭受火器伤的患者需要更多的复苏干预和大手术，如心包切开术、胸腔闭式引流术、开胸探查术和剖腹术。火器伤患者的平均住院时间（7.8天）比穿透性损伤患者（5.7天）和钝性创伤患者（6.0天）更长（P<0.001）。火器伤患者的住院死亡率（6.5%）高于穿透性损伤患者（0.6%）和钝性创伤患者（2.8%，P<0.001）。火器伤的总住院费用（30529美元）高于穿透性损伤（12243美元）和钝性创伤（18333美元，P<0.001）。即使在调整其他因素后，火器伤仍然是住院费用较高的显著预测因素（调整后的发病率比值比为1.256；P<0.001）。
尽管火器伤仅占总创伤病例的一定比例，但以干预措施和医院费用衡量，它们与更高的住院资源利用相关。这些发现凸显了需要集中开展预防工作和资源分配，以应对火器伤带来的独特挑战。
