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October 4, 2017

Study: Firearm-related injuries total $2.8B annually in ED, inpatient charges

Daily Briefing

Firearm-related injuries sent thousands of U.S. residents to hospital EDs from 2006 to 2014—totaling $24.9 billion in ED and inpatient charges, according to a new study published Monday in Health Affairs.

According to Modern Healthcare, the study was released to the press on an embargo before the mass shooting in Las Vegas Sunday night that injured more than 500 people and killed more than 50.  

The researchers, from Johns Hopkins University School of Medicine, noted a dearth of studies on firearm-related injuries and sought to identify epidemiological trends and calculate the clinical and financial burden associated with ED visits for firearm-related injuries. To do so, they analyzed data from the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project and focused on patients who went to the ED for firearm-related injuries from 2006 to 2014.


The researchers identified 150,930 patients with firearm-related injuries who arrived at a hospital ED alive from 2006 to 2014. The researchers estimated nationally the figure represented a total of 704,916 patients, or 25.3 ED visits per 100,000 people. The researchers found more than one-third of those patients were admitted to the hospital.

The researchers found that among the individuals who went to the ED with a firearm-related injury:

  • 48 percent—or 338,279 patients—were discharged home;
  • 37.2 percent—or 262,032—were admitted to inpatient care;
  • 7.7 percent—or 54,541—were discharged to additional care facilities; and
  • 5.2 percent—or 36,873—died during their ED visit.

According to the analysis, the mean per person charge for an ED visit linked to a firearm-related injury was $5,254, while the mean per person charge for inpatient care was $95,887. Overall, the researchers estimated that the financial burden associated with firearm-related injuries in terms of ED and inpatient charges was $24.9 billion over the eight-year study period, or about $2.8 billion annually.

Further, the researchers found ED visits for firearm-related injuries were most common among adults ages 20 to 24 at 85.7 visits per 100,000 people, and were nine times more common among men than women. The majority of individuals who went to the ED with a firearm-related injury were injured in an assault or unintentionally, according to the study.


Faiz Gani, study co-author and a postdoctoral research fellow in the Johns Hopkins School of Medicine's department of surgery, said the research paper's estimates are most likely conservative when considering all the services required to recover from a firearm-related injury, such as physical rehabilitation and mental health support. Gani said, "I think we're really just at the tip of the iceberg here," adding that "it's far, far more than we are able to capture right now in terms of the financial and clinical burden."

Gani added that much remains unknown about the societal cost of firearm-related injuries in part because Congress has routinely rejected legislation that would end restrictions on federal funding for certain research on gun violence. Congress enacted the restrictions in 1996 partly in response to concerns from gun-rights advocates that the research would lead to stricter gun regulations.

Noting that lack of research, Joseph Sakran, a researcher at Johns Hopkins School of Medicine also involved in the study, said the data from the research paper "becom[e] very important from a public health perspective" because it allows interventions to be tailored.

Some provider organizations have called for more federally funded research into the topic. For instance, Megan Ranney, a spokesperson for the American College of Emergency Physicians, said, "We should encourage funding agencies to conduct scientifically rigorous research on prevention, and how to help physicians, nurses, and the community at large process and overcome these events."

Tamera Coyne-Beasley, president of the Society for Adolescent Health and Medicine, said preventing firearm-related violence is "an issue that's going to require more than the research community to solve." She added, "Firearm violence is a leading cause of death among adolescents and young adults, and most of it is preventable. Further research could significantly prevent more injuries and deaths" (Ross Johnson, Modern Healthcare, 10/2; Baker, "Vitals," Axios, 10/2; Hugo, Newsweek, 10/3; Frieden, MedPage Today, 10/3).

This month: Learn how to reduce avoidable ED utilization

Heightened demand for emergency services and increased consumerism in health care has left emergency departments overburdened with rising costs and volumes.

Join us on Wednesday, October 18 at 1 pm ET to learn tactics to increase patient access to primary care, inflect patient behavioral change by boosting awareness of alternate care points and self-management strategies, and implement targeted measures for high-risk patients.

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