Song D H, Naude G P, Gilmore D A, Bongard F
Division of Trauma and Critical Care, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
J Trauma. 1996 May;40(5):810-5. doi: 10.1097/00005373-199605000-00022.
Gang related violence in Los Angeles County has increased, with homicides increasing from 205 in 1982 to 803 in 1992. This study examines the medical and financial consequences of such violence on a level I trauma center. Of 856 gunshot injuries over a 29-month period, 272 were gang related. There were 55 pediatric and 217 adult patients. Eighty-nine percent were male and 11% were female. Trauma Score averaged 14.7 +/- 3.1, Glasgow Coma Scale average score was 13.7 +/- 3.4, and the mean Injury Severity Score was 10.8 +/- 14. Twenty-two percent of the gunshots were to the head and neck, 20% to the chest, 20% to the abdomen, 6% had a peripheral vascular injury, and 33% sustained an extremity musculoskeletal injury. Emergency surgery was performed on 43%, including laparotomy 58 (49%), craniotomy 16 (13%), laparoscopy 14 (12%), vascular procedures 10 (8%), orthopedic procedures 6 (5%), head and neck endoscopies 4 (3%), thoracotomies 2 (2%), and 10 (8%) unspecified. There were 25 deaths (9%), primarily caused by head injuries and exsanguinating hemorrhage. Eighty-six percent entered the hospital during the hours of minimal staffing that preempted the use of facilities for other emergent patients. Charges totaled $4,828,828 (emergency room, surgical procedures, intensive care, and surgical ward stay) which equated to $5,550 per patient per day. Fifty-eight percent had no third party reimbursement, 22% had Medi-Cal, and 20% had medical insurance. Because of dismal reimbursement rates, the costs of gang violence are passed on to the tax payer. The cost of gang related violence cannot be derived from hospital charges only, because death, disability, and pain are not entered into the calculation. Education, increased social programs, and strict criminal justice laws and enforcement may decrease gang related violence and the drain it has on financial and medical resources.
洛杉矶县与帮派相关的暴力活动有所增加，凶杀案从1982年的205起增至1992年的803起。本研究调查了此类暴力行为对一家一级创伤中心造成的医疗和经济后果。在29个月期间的856例枪伤中，272例与帮派有关。其中有55名儿科患者和217名成年患者。89%为男性，11%为女性。创伤评分平均为14.7±3.1，格拉斯哥昏迷量表平均评分为13.7±3.4，平均损伤严重度评分为10.8±14。22%的枪伤位于头部和颈部，20%位于胸部，20%位于腹部，6%有周围血管损伤，33%有四肢肌肉骨骼损伤。43%的患者接受了急诊手术，包括剖腹手术58例（49%）、开颅手术16例（13%）、腹腔镜手术14例（12%）、血管手术10例（8%）、骨科手术6例（5%）、头颈部内镜检查4例（3%）、开胸手术2例（2%），还有10例（8%）未明确说明。有25例死亡（9%），主要由头部受伤和失血性出血导致。86%的患者在人员配备最少的时间段入院，这使得其他急诊患者无法使用相关设施。费用总计4828828美元（包括急诊室、外科手术、重症监护和外科病房住院费用），相当于每位患者每天5550美元。58%的患者没有第三方报销，22%有医疗救助，20%有医疗保险。由于报销率极低，帮派暴力的成本转嫁给了纳税人。与帮派相关的暴力成本不能仅从医院收费中得出，因为死亡、残疾和痛苦并未纳入计算。教育、增加社会项目以及严格的刑事司法法律和执法措施可能会减少与帮派相关的暴力活动以及它对财政和医疗资源的消耗。
