R. N. Smith1, S. Smith1, S. Jacoby1, S. Johnson1, N. Martin1, M. J. Seamon1 1University Of Pennsylvania,Traumatology, Surgical Critical Care And Emergency General Surgery,Philadelphia, PA, USA
Introduction: Retained bullets are common after the 70,000 firearm injuries that occur in the United States annually, yet their prevalence, impact on patient recovery, and ideal management strategy remain poorly understood. We sought to determine the practice patterns of US surgeons regarding their decision-making and management of retained bullets.
Methods: Surgeon members of a large, national trauma society were surveyed using an anonymous, web-based survey from April to May 2016. Data were collected on the demographic, institutional and professional background of respondents, along with current bullet removal practice patterns and psychological and procedural factors linked to bullet removal practices. These data were analyzed descriptively using STATA 14.
Results: Four hundred seventy-two surveys were returned (27.6% response rate) of which 45 (9.5%) with incomplete data were excluded. Of the final study sample of 427 surveys, the majority of respondents were male (n=327, 76.6%), and practicing Trauma Surgery (n=421, 98.6%) in urban (n=405, 94.8%), academic (n=377, 88.3%), Level I (n=311, 72.8%) trauma centers without a retained bullet management policy or guideline at their institution (n=365, 85%). Although 38% of respondents stated that their patients requested bullet removal either “always” or “almost always”, only 1% of surgeons performed bulletectomies either “always” or “almost always.” Conversely, only 3% of surveyed surgeons reported that their patients requested retained bullet removal either “almost never” or “never”, yet, 48% of surgeons reported that they remove bullets either “almost never” or “never” (Figure). Respondents identified potential pain relief (n=376, 88.1%) and superficial location (n=304, 71.2%) as the factors most influential to their bullet removal decision, but surgeons seldom considered the potential psychological impact (PTSD n=17, 4.0%; stress n=22, 5.1%; anxiety n=55, 12.9%) that retained bullets may have on their patients.
Conclusion: Despite frequent patient requests, our results suggest that most surgeons do not routinely remove retained bullets, nor do they consider the psychological impact of retained bullets when determining management strategies. Consideration of patient wishes along with the physiologic and the psychological impact of retained bullets is warranted.
