title: Impact of facial fractures and intracranial injuries on hospitalization outcomes following firearm injuries.
abstract: OBJECTIVE
  Firearm injuries (FAIs) play a major role in unintentional injuries, suicides, and homicides. It is important that policy makers, public health authorities, physicians, and the public are kept abreast of current trends in FAIs so that preventive programs can be tailored to the needs of cohorts that are at highest risk for such injuries.
  
  
  OBJECTIVE
  To provide nationally representative longitudinal estimates of outcomes associated with hospitalizations attributed to FAIs in all age groups in the United States during the years 2003 to 2010; to obtain prevalence estimates of skull and/or facial fractures and intracranial injuries among those hospitalized owing to firearm injuries; and to examine the association between the occurrence of skull and/or facial fractures and/or intracranial injuries and in-hospital mortality.
  
  
  METHODS
  In this retrospective analysis of the largest all-payer hospitalization data set in the United States, we evaluate a Nationwide Inpatient Sample of patients hospitalized for FAIs during the years 2003 to 2010.
  
  
  METHODS
  Face and/or skull fracture and/or intracranial injuries due to firearm injuries.
  
  
  METHODS
  The main outcome of interest was in-hospital mortality. The primary independent variables included occurrence of face and/or skull fracture and/or intracranial injuries. RESULTS During the study period, 252,181 visits were attributed to FAIs. Adolescents and young adults accounted for nearly 80% of all hospitalizations, with more than half of these in the 18- to 29-year-old, high-risk group. Male patients consistently accounted for 89% of the hospitalizations. The uninsured population accounted for nearly a third of hospitalizations. A total of 214,221 FAI hospitalizations did not involve facial and/or skull fractures or intracranial injuries; 13,090 involved a facial and/or skull fracture without a concomitant intracranial injury; 20,453 involved an intracranial injury without a concomitant facial and/or skull fracture; and 4417 involved both a facial and/or skull fracture and intracranial injury. Those with intracranial injuries without concomitant facial and/or skull fractures (odds ratio [OR], 58.40; 95% CI, 50.08-68.11) (P < .001) and those with both facial and/or skull fractures and intracranial injuries (OR, 17.45; 95% CI, 13.98-21.79) (P < .001) were associated with higher odds of in-hospital mortality than those without these injuries. Teaching hospitals were associated with higher odds of in-hospital mortality than nonteaching hospitals (OR, 1.31; 95% CI, 1.14-1.49) (P < .001). Teaching hospitals also tended to treat a higher proportion of complex cases. The uninsured had higher odds of in-hospital mortality than those with private insurance (OR, 1.55; 95% CI, 1.35-1.78).
  
  
  CONCLUSIONS
  AND RELEVANCE Occurrence of intracranial injuries was an independent risk factor for poor outcomes. Teaching hospitals had higher mortality rates but also treated more complex cases than nonteaching hospitals.
authors.affiliation: Department of Pediatric Critical Care, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Veerajalandhar
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: Department of Global Health, Harvard School of Dental Medicine, Boston, Massachusetts.
authors.forename: Romesh
authors.initials: R
authors.lastname: Nalliah
authors.affiliation: Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts.
authors.forename: Min Kyeong
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Texas A&M University Health Science Center, School of Rural Public Health, College Station, Texas.
authors.forename: Sankeerth
authors.initials: S
authors.lastname: Rampa
authors.affiliation: Department of Orthodontics, College of Dentistry, The University of Iowa, Iowa City.
authors.forename: Veerasathpurush
authors.initials: V
authors.lastname: Allareddy
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000209:etiology* / Q000401:mortality*; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012887:Skull Fractures / Q000209:etiology* / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000150:complications* / Q000401:mortality*