# The Impact of Gunshot Wounds on Healthcare Utilization in Trauma Patients: Retrospective Review of Trauma Centers in the United States

## TL;DR

This study finds that gunshot wound patients use more healthcare resources and face greater challenges in post-hospital care compared to non-gunshot wound trauma patients in the U.S.

## Contribution

The study provides new empirical evidence on the specific differences in healthcare utilization and insurance patterns between GSW and non-GSW trauma patients.

## Key findings

- GSW patients were more likely to be transported by helicopter and to be uninsured compared to non-GSW patients.
- GSW patients had longer ICU stays and were more likely to be discharged to psychiatric facilities after adjusting for other factors.
- GSW patients were more likely to have government-funded insurance compared to non-GSW patients.

## Abstract

Background

Gunshot wounds (GSW) contribute to poor patient outcomes and increased consumption of healthcare resources. The literature has expanded on the costs of treating patients with firearm injuries. However, further research is needed to understand the implications of GSW on healthcare resource utilization in trauma care. This study aims to compare hospital and post-hospital resource utilization between GSW and non-GSW trauma patients in the United States (US) trauma centers.

Methods

The National Trauma Data Bank (NTDB) was used to collect data retrospectively (2019-2021) on adult patients (age ≥18) admitted to US level 1 or 2 trauma centers. Bivariate and multivariable analyses were conducted to assess whether mode of transportation, health insurance, length of stay, or post-hospital discharge disposition were significantly different in GSW patients compared to non-GSW patients. Statistical significance was defined as p<0.05.

Results

We identified 1,596,079 trauma patients, of whom 106,844 were GSW patients (6.7%), and 1,489,235 were non-GSW patients (93.3%). GSW patients were transported by helicopter to a hospital more often compared to non-GSW patients for care (10.9% vs 8.1%) (X2 (1) = 928.6, p=5.9-204). Uninsured GSW patients ended up at a hospital with more frequency compared to uninsured non-GSW patients (31.9% vs 9.9%) (X2 (1) = 45,622.9, p<0.001). Healthcare was covered with government-funded insurance in GSW patients more often compared to non-GSW patients (66.9% vs 62.4%) (X2 (1) = 586.4, p = 1.5-129). A significant difference in the intensive care unit's length of stay was observed between the two groups (U = 7,260,338,161.0, Z = 7.6, p = 2.5-14). The mean rank for the GSW group was 220,491.8, whereas the mean rank for the non-GSW group was 215,328.7. The multivariable analysis indicated that GSW patients had increased odds of discharge to a psychiatric hospital or psychiatric distinct part unit of a hospital (aOR 1.5, CI 1.4 - 1.6, p=4.814-41) compared to non-GSW patients, when adjusting for age, sex, and mental/personality disorders' status.

Conclusion

GSW trauma is associated with high demands on acute care resources and significant gaps in post-hospital discharge support. GSW trauma underscores the importance of equitable, data-driven resource allocation strategies. A comprehensive and equity-oriented approach is warranted to enhance the efficiency and responsiveness of trauma care systems.