ORIGINAL CONTRIBUTION
Socioeconomic Aspects of Stab and Gunshot Wounds R. Edward Wase, Jr, MD Harold F. Hamit, MD Charlotte, North Carofina
Records of 294 patients with gunshot, stab, or shotgun wounds admitted to Charlotte Memorial Hospital and Medical Center between July 1, 1976 and June 30, 1977 were reviewed. Data were gathered on 24 clinical, social, and economic aspects to discover any patterns in these areas. Eighty-three percent of the patients were male; 71%, black; 70%, unmarried; and 56%, between 16 and 30 years of age. Fifty-five percent came to the hospital between 10 pm and 3 am; 57% on Friday, Saturday, or Sunday; 31% came in June, July, or August. Sixtyfour percent were gunshot wounds, 80% of which were by small caliber weapons.Ninety-four percent of all patients survived. The patients "consumed" 3,260 hospital days, 526 intensive care unit days, 533 units of blood, and 261 operations, totaling 595 hours of operating room time. Hospital charges totaled $668,000, of which 1.1% was paid from private funds and nearly 65% from the taxpayers and other private paying patients. Wase RE Jr, Hamit HF: Socioeconomic aspects of stab and gunshot wounds. JACEP 8:353-356, September 1979.
injury, gunshot; stabbing; socioeconomic factors, gunshot, stabbing
INTRODUCTION A socioeconomic profile of victims of gunshot, stab or shotgun wounds is of interest to emergency department personnel, the medical profession as a group, legislative and law enforcement agencies~ sociologists, and especially to the taxpayers, who involuntarily subsidize the cost of treatment. For this reason we undertook a study of 294 patients who sustained such wounds. These statistics are compared with a study by Jett et al of 254 similar injuries at Charlotte Memorial Hospital and Medical Center in 1969.1 MATERIALS AND METHODS The clinical records of all inpatients treated for gunshot, stab or shotgun wounds from July 1, 1976 to June 30, 1977 were reviewed. Two hundred ninetyfour charts were studied, with data gathered in 24 areas: age, sex, race, marital status, date of admission, day of week, week of month, time of day, type of injury (weapon used), site of injury, discharge status (alive or dead), major operations, minor operations, operating room time, units of blood, hospital days, intensive care unit (ICU) days, hospital charges, amount paid, source of payment, admitting service, alcohol or drug involvement, nature of incident (accidental, suicide, altercation, alleged crime involved), and any previous or later hospital visits for these injuries. Most demographic and financial data on inpatients is stored on computer records, and patients were selected from these computer records by From the Department of Emergency Medicine, C-CharlotteMemorial Hospital, Charlotte, North Carolina. Address for reprints: R. Edward Wase, Jr, MD, Charlotte Memorial Hospital, Box 32861, Charlotte, North Carolina 28232. 8:9 (September) 1979
JACEP
353/21
diagnosis (primary or secondary) of gunshot, stab or shotgun wounds. Clinical review and data gathering was accomplished manually. Outpatient records were not computerized and manual review of 80,000 emergency department visits was impossible. Thus those t r e a t e d .and released, or those DOA or expired in the emergency department are not included in this study.
40. PATIENT~ 32
301--20i
13
13 1 3 ~
~
3
RESULTS
Eight-three percent of the patients were male. T h i r t y percent were married (Table 1). Fifty-six percent of the patients were between 16 and 30 years of age (Figure 1). The population of Charlotte is approximately 75% white and 25% nonwhite (telephone conversation, Charlotte Chamber of Commerce). The patients in our study were 71% black and .28% white and, therefore, significantly different from the general population• Gunshot wounds ac-
Percent
245 49
83 17
~ 133 88 44 21 7
45 30 15 7 2
Male Female Single Married Separated Divorced Widowed
t t ! , I I I I i I= I I I I I I I /
60 PATIENTS
59 45
] | i
[ i
Fig. 2. Distribution of patients by time of day. counted for 64% of the injuries, while 32% were admitted for stab wounds and 5% for shotgun wounds. Thirtynine weapons were documented for caliber in the charts, and 80% of these were .22 and .32 caliber. Of the stab wounds, two were by ice pick, one by butcher knife, one by razor, and the r e m a i n d e r unclear in the charts. Two h u n d r e d seventy-six (94%) patients were discharged alive, while 18 (6%) died. Of those with fatal injuries, five had abdominal gunshot wounds, one had an abdominal stab wound, two received g u n s h o t wounds to the chest, two h a d stab wounds to the chest, one a shotgun wound to
Table 1 SEX A N D M A R I T A L STATUS n = 294 No
Oil
58
the chest, and one a shotgun wound to the abdomen. Five patients with gunshot wounds of the head died, and one p a t i e n t with g u n s h o t wounds to the chest and abdomen died. This is in contrast to Jett's findings 1 in 1969 of head injuries in 8 of 11 fatalities, and a total survival rate of 95.5%. Time and Date of Admission
The exact time and date of admission were recorded by time clock on all charts. Fifty-five percent arrived at the hospital between 10 pm and 3 am (Figure 2). Seventeen percent of the emergency department's average daily census (all visits) for June 1977 were between 10 pm and 3 am. Over 57% came on Friday, Saturday, and Sunday (Table 2). Approximately 30% were admitted during June, July, and August (Table 3).
49
3"/
Table 2 CENSUS BY DAY OF WEEK n -- 294
34
15
Age:Un~15 16-20 21-25 26-30 31-35 36-40
41-45 46-50 51-55 56"60 Over60
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
No
Percent
32 25 38 32 49 76 42
1i 8 13 11 17 26 14
Fig. 1. Distribution of patients by age. 22/354
JACEP
8:9 (September) 1979
Table 5 A D M I T T I N G SERVICES n = 294
Table 3 C E N S U S BY M O N T H OF Y E A R n = 294
No
July August September October November December Jan uary February March April May June
31 31 17 32 17 24 23 11 25 26 25 32
Percent
10 10 6 11 6 8 8 4 8 9 8 11
Table 4 L O C A T I O N O F INJURY n = 294
Abdomen Chest Extremities Head Neck Back Face Genitals Rectum
No
Percent
82 77 77 27 14 12 9 3 1
28 26 26 9 5 4 3 1
Socioeconomic Aspects of Stab and Gunshot Wounds R. Edward Wase, Jr, MD Harold F. Hamit, MD Charlotte, North Carofina
Records of 294 patients with gunshot, stab, or shotgun wounds admitted to Charlotte Memorial Hospital and Medical Center between July 1, 1976 and June 30, 1977 were reviewed. Data were gathered on 24 clinical, social, and economic aspects to discover any patterns in these areas. Eighty-three percent of the patients were male; 71%, black; 70%, unmarried; and 56%, between 16 and 30 years of age. Fifty-five percent came to the hospital between 10 pm and 3 am; 57% on Friday, Saturday, or Sunday; 31% came in June, July, or August. Sixtyfour percent were gunshot wounds, 80% of which were by small caliber weapons.Ninety-four percent of all patients survived. The patients "consumed" 3,260 hospital days, 526 intensive care unit days, 533 units of blood, and 261 operations, totaling 595 hours of operating room time. Hospital charges totaled $668,000, of which 1.1% was paid from private funds and nearly 65% from the taxpayers and other private paying patients. Wase RE Jr, Hamit HF: Socioeconomic aspects of stab and gunshot wounds. JACEP 8:353-356, September 1979.
injury, gunshot; stabbing; socioeconomic factors, gunshot, stabbing
INTRODUCTION A socioeconomic profile of victims of gunshot, stab or shotgun wounds is of interest to emergency department personnel, the medical profession as a group, legislative and law enforcement agencies~ sociologists, and especially to the taxpayers, who involuntarily subsidize the cost of treatment. For this reason we undertook a study of 294 patients who sustained such wounds. These statistics are compared with a study by Jett et al of 254 similar injuries at Charlotte Memorial Hospital and Medical Center in 1969.1 MATERIALS AND METHODS The clinical records of all inpatients treated for gunshot, stab or shotgun wounds from July 1, 1976 to June 30, 1977 were reviewed. Two hundred ninetyfour charts were studied, with data gathered in 24 areas: age, sex, race, marital status, date of admission, day of week, week of month, time of day, type of injury (weapon used), site of injury, discharge status (alive or dead), major operations, minor operations, operating room time, units of blood, hospital days, intensive care unit (ICU) days, hospital charges, amount paid, source of payment, admitting service, alcohol or drug involvement, nature of incident (accidental, suicide, altercation, alleged crime involved), and any previous or later hospital visits for these injuries. Most demographic and financial data on inpatients is stored on computer records, and patients were selected from these computer records by From the Department of Emergency Medicine, C-CharlotteMemorial Hospital, Charlotte, North Carolina. Address for reprints: R. Edward Wase, Jr, MD, Charlotte Memorial Hospital, Box 32861, Charlotte, North Carolina 28232. 8:9 (September) 1979
JACEP
353/21
diagnosis (primary or secondary) of gunshot, stab or shotgun wounds. Clinical review and data gathering was accomplished manually. Outpatient records were not computerized and manual review of 80,000 emergency department visits was impossible. Thus those t r e a t e d .and released, or those DOA or expired in the emergency department are not included in this study.
40. PATIENT~ 32
301--20i
13
13 1 3 ~
~
3
RESULTS
Eight-three percent of the patients were male. T h i r t y percent were married (Table 1). Fifty-six percent of the patients were between 16 and 30 years of age (Figure 1). The population of Charlotte is approximately 75% white and 25% nonwhite (telephone conversation, Charlotte Chamber of Commerce). The patients in our study were 71% black and .28% white and, therefore, significantly different from the general population• Gunshot wounds ac-
Percent
245 49
83 17
~ 133 88 44 21 7
45 30 15 7 2
Male Female Single Married Separated Divorced Widowed
t t ! , I I I I i I= I I I I I I I /
60 PATIENTS
59 45
] | i
[ i
Fig. 2. Distribution of patients by time of day. counted for 64% of the injuries, while 32% were admitted for stab wounds and 5% for shotgun wounds. Thirtynine weapons were documented for caliber in the charts, and 80% of these were .22 and .32 caliber. Of the stab wounds, two were by ice pick, one by butcher knife, one by razor, and the r e m a i n d e r unclear in the charts. Two h u n d r e d seventy-six (94%) patients were discharged alive, while 18 (6%) died. Of those with fatal injuries, five had abdominal gunshot wounds, one had an abdominal stab wound, two received g u n s h o t wounds to the chest, two h a d stab wounds to the chest, one a shotgun wound to
Table 1 SEX A N D M A R I T A L STATUS n = 294 No
Oil
58
the chest, and one a shotgun wound to the abdomen. Five patients with gunshot wounds of the head died, and one p a t i e n t with g u n s h o t wounds to the chest and abdomen died. This is in contrast to Jett's findings 1 in 1969 of head injuries in 8 of 11 fatalities, and a total survival rate of 95.5%. Time and Date of Admission
The exact time and date of admission were recorded by time clock on all charts. Fifty-five percent arrived at the hospital between 10 pm and 3 am (Figure 2). Seventeen percent of the emergency department's average daily census (all visits) for June 1977 were between 10 pm and 3 am. Over 57% came on Friday, Saturday, and Sunday (Table 2). Approximately 30% were admitted during June, July, and August (Table 3).
49
3"/
Table 2 CENSUS BY DAY OF WEEK n -- 294
34
15
Age:Un~15 16-20 21-25 26-30 31-35 36-40
41-45 46-50 51-55 56"60 Over60
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
No
Percent
32 25 38 32 49 76 42
1i 8 13 11 17 26 14
Fig. 1. Distribution of patients by age. 22/354
JACEP
8:9 (September) 1979
Table 5 A D M I T T I N G SERVICES n = 294
Table 3 C E N S U S BY M O N T H OF Y E A R n = 294
No
July August September October November December Jan uary February March April May June
31 31 17 32 17 24 23 11 25 26 25 32
Percent
10 10 6 11 6 8 8 4 8 9 8 11
Table 4 L O C A T I O N O F INJURY n = 294
Abdomen Chest Extremities Head Neck Back Face Genitals Rectum
No
Percent
82 77 77 27 14 12 9 3 1
28 26 26 9 5 4 3 1
