Gunshot Victims Use More Blood, Cost More to Treat, More Likely to Die

A new study examines 12 years of trauma records and finds high mortality rates for shooting victims, despite the volumes of blood and resources used in attempts to save them.

It's no surprise that gunshot victims require a lot more blood transfusions, cost a lot more to treat, and are more likely to die than other trauma patients.

Now, a new study this month in the journal Transfusion shows just how much.

Researchers at The Johns Hopkins University examined the Maryland state trauma registry from 2005 to 2017 and found that gunshot victims are five times more likely to require blood transfusions, require 10 times more blood units and are 14 times more likely to die than people seriously injured by motor vehicles, non-gun assaults, falls or stabs.

"Blood products cost a lot, come with a lot of risks for those transfused, and are scarce, so understanding what kinds of trauma are most likely to require more of them can help hospitals improve outcomes for trauma victims," study corresponding author Steven Frank, MD, professor of anesthesiology and critical care medicine at Johns Hopkins, said in remarks accompanying the study.

Frank and colleagues analyzed data from 23,422 Johns Hopkins Hospital trauma patients entered into the Maryland trauma registry over the 12-year timeframe.

The study found that:

• The average age for GSW (gunshot wound) patients was 27 and the average for non-GSW patients was 38. Males made up 93% of GSW patients and 67% of non-GSW patients.
   
• Of all patients in the trauma registry, 2,672 (11%) had GSW injuries and 20,750 (89%) had non-GSW trauma injuries resulting from motor vehicle, non-gun assaults, falls or stabs. GSW patients were five times more likely to require a blood transfusion (538 of 2,672, or 20%) compared to non-GSW patients (798 of 20,750, or 4%).
   
• When comparing all patients, the researchers found that GSW patients needed 10 times more units of blood than non-GSW patients (3.3 units versus .31 units for non-GSW patients).
   
• Frank and colleagues also found that GSW patients were more likely to die in the emergency department (69 of 2,672, or 2.6%) than non-GSW patients (17 of 20,750, or 0.08%). Overall, GSW patients were about 14 times more likely to die (653 of 2,672, or 24%) than non-GSW patients (352 of 20,750, or 1.7%).

"The most likely explanation for these findings is the dramatic degree of injury severity in gunshot victims compared to all other types of trauma, including stab wounds," Frank said.

More than 116,000 people are injured and 38,000 people are killed from gun-related injuries in the United States each year.  

The financial burden of caring for gunshot victims is also heavy.

• The researchers compared two types of costs for transfusions: acquisition costs, or the cost of the unit itself ($200 per unit of red blood cells, $500 per unit of platelets, $50 per unit of plasma and $250 per dose of cryoprecipitate); and activity based costs, which are acquisition costs plus a fourfold increase for overhead that includes storage, viral testing, transport, compatibility testing and the cost of giving the blood to the patient.
   
• Although overall, only 11.4% of all trauma patients had GSW injuries, more money was spent on blood for these patients than for all non-GSW trauma patients combined: $1.5 million for GSW patients versus $1.1 million for non-GSW patients in acquisition costs, and $6.1 million versus $4.6 million for non-GSW activity costs.

"For emergency preparedness purposes, hospitals that treat trauma need to have a sufficient amount of blood in the bank in order to treat patients coming in with gunshot wounds," Frank said.