title: Survivors of self-inflicted gunshot wounds to the head: characterization of ocular injuries and health care costs.
abstract: OBJECTIVE
  Suicides and attempted suicides are major public health issues in the United States and around the world. Self-inflicted gunshot wounds (SIGSWs) are a common method of attempting suicide, the head being the most commonly injured body region; however, the literature lacks an overview of the orbital and ocular injuries as well as outcomes associated with SIGSWs.
  
  
  OBJECTIVE
  To characterize the ocular and orbital injuries and outcomes of patients presenting with SIGSWs and to examine the cost associated with these injuries.
  
  
  METHODS
  Retrospective medical record review was performed of all patients who presented to the University of Iowa Hospitals and Clinics between 2003 to 2013 with the admitting diagnosis of self-inflicted injuries via firearms. Patients with no periorbital or ocular injuries and/or those who did not survive for at least 2 months following the incident were excluded.
  
  
  METHODS
  Ocular injuries and outcomes and health care costs and reimbursements, which were generated by a financial report obtained from the hospital finance department that included data from both the hospital billing and cost accounting systems.
  
  
  RESULTS
  All patients in this study (n = 18) were men with a mean age of 47.2 years. Eight patients (44.4%) displayed submental missile entry points, 7 (38.9%) displayed intraoral entry points, and 3 (16.7%) displayed pericranial entry points. Patients with pericranial entries sustained more severe ocular injuries and had poorer ocular outcomes. Seven patients (38.9%) were found at final follow-up to have visual acuity of 20/40 or better in each eye and all showed missile trajectories in the sagittal plane. The mean cost of treatment of these patients totaled $117,338 while the mean reimbursement amount was $124,388.
  
  
  CONCLUSIONS
  Data regarding ocular injuries and outcomes may assist ophthalmologists in the treatment of patients with SIGSWs in the future. Many patients had extremely functional vision at final follow-ups, which highlights the importance of specialists conducting examinations and reconstructive procedures promptly, carefully, and thoroughly. Cost and reimbursement data suggest that while these cases place a large financial burden on society, they may not burden hospital systems in the same way.
authors.affiliation: Carver College of Medicine, University of Iowa, Iowa City.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Reddy
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City.
authors.forename: Meredith S
authors.initials: MS
authors.lastname: Baker
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City.
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Sobel
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City.
authors.forename: David A
authors.initials: DA
authors.lastname: Whelan
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City4Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Carter
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City4Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Allen
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000191:economics* / Q000209:etiology; D016208:Databases, Factual; D005131:Eye Injuries / Q000175:diagnosis / Q000191:economics* / Q000209:etiology; D017048:Health Care Costs; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000150:complications* / Q000523:psychology; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D017741:Survivors; D016896:Treatment Outcome; D014481:United States; D014948:Wounds, Gunshot / Q000150:complications / Q000191:economics* / Q000523:psychology; D055815:Young Adult