title: Medical and economic consequences of gang-related shootings.
abstract: Treatment costs for victims of gang violence have fueled the withdrawal of hospitals from trauma networks. Not included in such tallies are the medical resources that these seriously ill and medically indigent patients divert from other areas. We examined the surgical care requirements, costs incurred, and outcomes at a Level I trauma center. Local law enforcement records were matched with hospital admissions over a 1-year period to identify with hospital admissions over a 1-year period to identify casualties of gang violence. Of 191 gunshot wound admissions, 107 (56%) were gang related. The majority were males (92%); ages ranged from 14 to 50 and trauma scores from 1-16. Eighty-six were admitted during periods of minimum staffing (7:00 PM to 7:00 AM), pre-emptying the use of limited resources for other medical/surgical emergencies. Fifty-eight (54%) needed emergency surgery: laparotomy (38), thoracotomy (5), and neck/extremity (15). Forty required multiple surgical procedures, and eight patients required nine subsequent surgeries. There were two deaths. Average hospital stay ranged from 1 to 180 days; inpatient days totalled 1003, 270 of which were spent in the ICU. Total charges neared +2.0 million. Ninety-four patients (88%) were medically indigent. On discharge, 75 patients were disabled, six permanently. We conclude: 1) Gang activity caused the majority of gunshot wounds at our trauma center; 2) multiple injuries predominated, requiring extensive ICU use; 3) the combination of indigent patients and high hospital costs underestimate the financial burden as valuable resources are diverted from other areas; 4) subsequent community costs include rehabilitation and chronic care.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
authors.forename: M
authors.initials: M
authors.lastname: Ryan
authors.forename: T
authors.initials: T
authors.lastname: Leighton
authors.forename: N
authors.initials: N
authors.lastname: Pianim
authors.forename: S
authors.initials: S
authors.lastname: Klein
authors.forename: F
authors.initials: F
authors.lastname: Bongard
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D004630:Emergencies; D005260:Female; D015600:Glasgow Coma Scale; D006271:Health Facility Closure; D006746:Hospital Bed Capacity, 500 and over; D017721:Hospital Costs; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009104:Multiple Trauma / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D014193:Trauma Centers / Q000191:economics* / Q000706:statistics & numerical data; D014754:Violence / Q000191:economics* / Q000706:statistics & numerical data; D014948:Wounds, Gunshot / Q000191:economics* / Q000453:epidemiology / Q000601:surgery