Survivors of self-inflicted gunshot wounds to the head: characterization of ocular injuries and health care costs

Amit K Reddy; Meredith S Baker; Rachel K Sobel; David A Whelan; Keith D Carter; Richard C Allen

doi:10.1001/jamaophthalmol.2013.8201

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Survivors of self-inflicted gunshot wounds to the head: characterization of ocular injuries and health care costs

Journal article

Open access

Peer reviewed

Survivors of self-inflicted gunshot wounds to the head: characterization of ocular injuries and health care costs

Amit K Reddy, Meredith S Baker, Rachel K Sobel, David A Whelan, Keith D Carter and Richard C Allen

JAMA ophthalmology, Vol.132(6), pp.730-736

06/2014

DOI: 10.1001/jamaophthalmol.2013.8201

PMCID: PMC5175460

PMID: 24676273

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Published (Version of record) Open Access

Abstract

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. To characterize the ocular and orbital injuries and outcomes of patients presenting with SIGSWs and to examine the cost associated with these injuries. 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. 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. 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. 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.

Wounds, Gunshot - psychology

United States

Humans

Middle Aged

Suicide, Attempted - statistics & numerical data

Wounds, Gunshot - complications

Male

Injury Severity Score

Wounds, Gunshot - economics

Young Adult

Eye Injuries - etiology

Self-Injurious Behavior - complications

Aged, 80 and over

Adult

Eye Injuries - economics

Retrospective Studies

Databases, Factual

Eye Injuries - diagnosis

Self-Injurious Behavior - psychology

Survivors

Craniocerebral Trauma - diagnosis

Treatment Outcome

Academic Medical Centers

Suicide - statistics & numerical data

Craniocerebral Trauma - etiology

Suicide, Attempted - psychology

Craniocerebral Trauma - economics

Health Care Costs

Adolescent

Aged

Details

Title: Subtitle: Survivors of self-inflicted gunshot wounds to the head: characterization of ocular injuries and health care costs
Creators: Amit K Reddy - Carver College of Medicine, University of Iowa, Iowa City
Meredith S Baker - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
Rachel K Sobel - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
David A Whelan - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City
Keith D Carter - 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
Richard C Allen - 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
Resource Type: Journal article
Publication Details: JAMA ophthalmology, Vol.132(6), pp.730-736
DOI: 10.1001/jamaophthalmol.2013.8201
PMID: 24676273
PMCID: PMC5175460
NLM abbreviation: JAMA Ophthalmol
ISSN: 2168-6165
eISSN: 2168-6173
Publisher: United States
Grant note: T35 HL007485 / NHLBI NIH HHS
Language: English
Date published: 06/2014
Academic Unit: Otolaryngology; Ophthalmology and Visual Sciences
Record Identifier: 9983980040802771

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11 Times Cited - Web of Science