Facial Fractures in Patients with Firearm Injuries: Profile and Outcomes

Publication date: Available online 8 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shelly Abramowicz, Veerasathpurush Allareddy, Sankeerth Rampa, Min Kyeong Lee, Romesh P. Nalliah, Veerajalandhar Allareddy
PurposeFirearm injuries are a major public health issue in the United States (US). The objective of this study was to examine characteristics and outcomes of patients presenting to emergency departments (ED) with facial fractures attributed to firearm injuries (FAIs).Materials and MethodsThe Nationwide Emergency Department Sample for the years 2008 to 2013 was used. All patients that visited an ED with a FAI and facial fractures were selected. The study focused on the following variables: (1) demographics, (2) types of facial fractures, (3) disposition status after ED visit or subsequent hospitalization, (4) charges (ED and hospitalization), and (5) patient outcomes. Inclusion criteria were a visit to hospital based ED with facial fractures and an external cause of FAI. Descriptive statistics were used to summarize findings. Multivariable logistic regression analysis was used to examine the simultaneous effects of patient related factors on ED mortality.ResultsDuring the study period, a total of 15,469 patients (mean age 34 years) visited hospital based EDs with a facial fracture attributed to FAIs. Majority were uninsured males. The most common etiology for FAI was assault. Most common facial fractures were open mandibular fractures and open maxillary/malar bone fractures. Approximately 27% had a concomitant intra-cranial injury. Following the ED visit, 74% were admitted. Mean ED charge per patient was $6,403 and total ED charges across the US was $76.48 million. Mean hospitalization charge per patient was $167,203. Total hospitalization charges across the US was $1.9 billion. Those with intra-cranial injuries (OR=21.21, 95% CI=7.16 – 62.85, p<0.01), uninsured (OR=4.24, 95% CI=1.44 – 12.51, p<0.01), and those residing in high household income areas (OR=5.60, 95% CI=2.51 – 12.46, p<0.01) were high risk groups for ED mortality.ConclusionsFAIs require significant resources for stabilization and treatment by EDs. The present study highlights the burden and impact of facial fractures in patients with FAIs in the US.



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