Utilization, Care Access, and Cost for Ballistic Injuries of the Hand and Wrist: A Comparison of Violent and Self-Inflicted Injuries

Purpose We sought to quantify care utilization, access to care, and cost for self-inflicted firearm injuries to the hand and wrist compared with violently inflicted injuries. We hypothesized that self-inflicted injuries would require equal or greater health care resources, representing a distinct population with unique barriers to care. Methods We performed a retrospective cohort study of adult patients with hand or wrist gunshot wounds treated at a single health system from 2015 to 2022. Demographic, treatment, access, and cost data were analyzed to compare self-inflicted and violent injury cohorts. Results A total of 244 injuries were included (162 violent and 82 self-inflicted). Patients with self-inflicted injuries were more likely to be older, employed, and White, whereas violently injured patients had higher area deprivation indices and Medicaid coverage. Self-inflicted injuries occurred more frequently in rural areas, required interfacility transfer, and were located farther from treating centers. Operative intervention was more common in self-inflicted injuries, with a higher number of procedures per patient. Physician charges billed and collected were significantly greater in the self-inflicted cohort. Over time, self-inflicted injuries represented an increasing proportion of cases, with increasing total and per-patient cost to treat these injuries. Conclusions Self-inflicted and violently inflicted firearm injuries represent distinct patient populations with different barriers to care. Both injury patterns create substantial economic impact, and self-inflicted injuries are associated with greater operative utilization and increasing financial burden, highlighting an underrecognized contributor to the cost of upper extremity trauma care. Type of study/level of evidence Economic/decision analysis III.