Costs of care for low-energy extremity gunshot injuries are reduced with standardized treatment.

Objectives (1) to determine the overall treatment costs associated with isolated low-energy GSWs to the extremity and (2) to estimate cost savings associated with a single-dose IV antibiotic strategy administered in the Emergency Room for patients with simple GSWs. Design Retrospective review. Setting Level I trauma center. Patients/participants Patients (N=380) with extremity-only GSW injuries from 2010-2015 were retrospectively reviewed. Treatment was recorded including type and duration of antibiotics, admission, and surgical intervention. Main outcome measures Costs were calculated including facility services in the operating room, and hospital. Results There were 460 GSWs in 380 patients with mean age was 30 years old. There were 309 admissions, 273 operations performed, and 1,010 days of antibiotics prescribed. The total inpatient facility cost to treat all patients was $1,701,154. Among 179 patients who could be treated via the single-dose antibiotic care pathway for simple GSWs, 132 patients (73%) received additional treatment with 108 hospital admissions, 26 debridement surgeries, and 322 days of additional oral and/or IV antibiotics. The single-dose antibiotic care pathway would have saved an average of $1,436 per patient with simple GSWs in actual facility expenses. Conclusions The overall cost associated with isolated low-energy GSWs to the extremity is high. Limiting antibiotics to a single IV dose in the Emergency Room can reduce treatment expenses substantially for patients with simple GSWs. Level of evidence Economic and Decision Analyses Level III. See Instructions for Authors for a complete description of levels of evidence.