Ordog G J, Wasserberger J, Ackroyd G
Department of Emergency Medicine and Trauma Service, Martin Luther King, Jr. General Hospital.
J Trauma. 1995 Feb;38(2):291-8. doi: 10.1097/00005373-199502000-00029.
The purpose of this study was to provide economic, epidemiologic, and clinical data on initial hospitalizations of patients with firearm injuries.
Concurrent prospective study; data obtained by medical records review.
A county university teaching hospital designated a level I trauma center.
34,893 persons first hospitalized for firearm injuries at the King/Drew Medical Center in Los Angeles from January 1978 through December 1992.
The aggregate hospital cost for 34,893 firearm injuries, exclusive of professional fees, was $264,506,455.00, of which 96% was borne directly or indirectly by public funds. The charge for initial hospitalizations was $240,700,855.00. Mean and median initial charges per case were $6898.00 and $1,022.00, respectively (range, $944.00 to $296,232.00). The 5% of patients with charges greater than $100,000 accounted for 42% of all charges; 45% of all patient days were attributable to the 4% patients, with hospitalizations lasting more than 30 days. Three thousand thirty-one patients were rehospitalized a total of 4,578 times; charges for rehospitalization totaled $23,805,600.00. At least 55% (75% of identifiable weapon and missile injuries) of all charges resulted from handgun injuries. Treating the majority of patients on an outpatient basis and by using selective angiography for extremity wounds, a savings of more than $775,000,000.00 resulted. The potential cost of treating gunshot wounds at a single county hospital was more than $1 billion, or more than $100 million per year.
The costs for hospital treatment of firearm injuries are substantial. A lack of rehabilitation facilities forces prolonged acute hospital admissions in many cases. Avoiding prolonged hospitalization may be helpful in controlling these costs, but will be difficult to achieve. Ninety-six percent of the patients in this report had their costs of care covered by the government, because they had no primary insurance coverage. Primary prevention of firearm injuries, especially those caused by handguns, may be the most effective cost-control measure.
本研究的目的是提供有关火器伤患者首次住院治疗的经济、流行病学和临床数据。
同期前瞻性研究；通过病历回顾获取数据。
一所被指定为一级创伤中心的县立大学教学医院。
1978年1月至1992年12月期间在洛杉矶国王/德鲁医疗中心首次因火器伤住院的34893人。
34893例火器伤的总住院费用（不包括专业费用）为264506455.00美元，其中96%由公共资金直接或间接承担。首次住院费用为240700855.00美元。每例患者的平均和中位数首次费用分别为6898.00美元和1022.00美元（范围为944.00美元至296232.00美元）。费用超过10万美元的5%患者占所有费用的42%；45%的总住院天数归因于4%住院时间超过30天的患者。3031名患者再次住院共计4578次；再次住院费用总计23805600.00美元。所有费用中至少55%（可识别的武器和导弹伤中的75%）是由手枪伤导致的。通过在门诊治疗大多数患者以及对四肢伤口采用选择性血管造影，节省了超过7.75亿美元。一家县医院治疗枪伤的潜在成本超过10亿美元，即每年超过1亿美元。
火器伤的医院治疗费用巨大。缺乏康复设施在许多情况下导致急性住院时间延长。避免长时间住院可能有助于控制这些费用，但难以实现。本报告中96%的患者的护理费用由政府支付，因为他们没有基本保险。火器伤的一级预防，尤其是由手枪导致的伤害，可能是最有效的成本控制措施。
