Introduction: The object of this study is to examine inpatient care for children with traumatic brain injury (TBI) secondary to cranial gunshot wounds (GSW) and to identify factors associated with in-hospital mortality.
Methods: The 2012 Healthcare Cost and Utilization Project (HCUP) Kids´ Inpatient Database (KID) was used to identify pediatric admissions for TBI from cranial GSW using ICD-9 diagnosis and procedure codes. Hospital charges, length of stay, and variables associated with in-hospital mortality were assessed. Unweighted, the 2012 KID contains 3,195,782 discharges. Weighted, it estimates 6,675,222 discharges nationwide in the USA.
Results: In the 2012 KID there were 423 observations, estimating an actual national total of 590 discharges for pediatric TBI with firearm injury. The mean hospital charge was $151,132 (SEM $11,130) and total hospital charges were $62,115,604 (weighted, estimates hospital charges of $86,240,364). Medicare and Medicaid charges totaled $32,904,113 (weighted, estimates total charges of $45,213,663).The mean length of stay was 8 days (SEM0.60), totaling 3,494 hospital days (weighted, estimates 4891 total hospital days). The majority of patients were adolescents (81% aged 16+ years, 342 patients) or older children (12% aged 11-15 years, 49 patients). 31 patients were young children (7%, aged 0-10 years). 39% of patients died (167 deaths). The occurrence of an operative procedure was a significant indicator of survival - possibly as an indirect measure of injury severity: 85% of patients who underwent an operative procedure survived, compared to 40% of patients who did not undergo an operative procedure (p<0.001). No difference in mortality was observed by weekend (vs. weekday) admission status or by race. In 26% of cases, the firearm injury occurred in the home. However, among children aged 10 years and younger, 64% of injuries occurred in the home.
Conclusions: Pediatric TBI from cranial GSW hospitalizations are associated with high mortality and significant costs.
Patient Care: A better understanding of factors that lead to decreased inpatient mortality in pediatric cranial gunshot wounds may lead to improved management and outcomes with these injuries.
Learning Objectives: To examine the magnitude of pediatric cranial gunshot wounds and factors associated with inpatient mortality.