Hospitalizations and healthcare costs associated with serious, non-lethal firearm-related violence and injuries in the United States, 1998-2011

Objective:To describe the prevalence,trends,correlates,and short-term outcomes of inpa-tient hospitalizations for firearm-related injuries(FRIs)in the United States between 1998 and 2011.Methods:We conducted a retrospective,cross-sectional analysis of inpatient hospitalizations using data from the Nationwide Inpatient Sample.In addition to generating national prevalence estimates,we used survey logistic regression to calculate odds ratios(ORs)and 95%confidence intervals(CIs)for the association between FRIs and patient/hospital-level characteristics.Tempo-ral trends were estimated and characterized using joinpoint regression.Results:There were 10.5 FRIs(95%CI:9.2-11.8)per 10,000 non-maternal/neonatal inpatient hospitalizations,with assault accounting for 60.1%of FRIs,followed by unintentional/accidental(23.0%)and intentional/self-inflicted FRIs(8.2%).The highest odds of FRIs,particularly FRIs associated with an assault,was observed among patients 18-24 years of age,patients 14-17 years of age,patients with no insurance/self-pay,and non-Hispanic blacks.The mean inpatient length of stay for FRIs was 6.9 days;however,4.7%of patients remained in the hospital over 24 days and 1 in 12 patients(8.2%)died before discharge.The mean cost of an inpatient hospitalization for a FRI was$22,149,which was estimated to be$679 million annually;approximately two-thirds of the annual cost(64.7%)was for assault($439 million).Conclusion:FRIs are a preventable public health issue which disproportionately impacts younger generations,while imposing significant economic and societal burdens,even in the ab-sence of fatalities.Prevention of FRIs should be considered a priority in this era of healthcare cost containment.

Modified Advanced Life Support in Obstetrics course: Feasibility, trainee satisfaction, and sustainability potential

Objective:The main objective of this initiative was to present evaluation results from an inno-vative adaptation of the Advanced Life Support in Obstetrics(ALSO)training course.We modified the traditional ALSO curriculum in our institution by adding hands-on training in laceration repairs and simulation scenarios on acute maternity care.Methods:The modified ALSO provider course was designed to enhance cognitive and proce-dural skills of health care professionals in managing obstetric emergencies.Forty-nine participants attended this course and completed a posttraining survey.Descriptive statistics were used to de-scribe the participant-reported assessment scores for the ALSO course on three domains(subject knowledge,organization and clarity,and teaching effectiveness)for each of 12 course topics.Results:Evaluation of the results showed a high rate of trainee satisfaction as evidenced by the mean assessment scores across all topics ranging from 4.80 to 4.98(out of 5.00).All trainees said they would refer others to the course.Our modified ALSO course effectively addressed the important needs of primary care physicians involved in maternity care,especially in underserved communities where specialized obstetric care is not readily available.Both simulation scenarios and workshops using simulated human tissue provide a better foundation before formal training.Conclusion:Given the changing legal and regulatory climate,we expect that learning to treat complex obstetric situations on the job will become increasingly risky.With this in mind,both simulation scenarios and workshops using simulated human tissue will provide a better foundation before formal training.