R. Maduka1, S. Resnick1,2, V. Kumar1, S. Jacoby3, M. Seamon1,2, R. Smith4 1University Of Pennsylvania,The Perelman School Of Medicine,Philadelphia, PA, USA 2Hospital Of The University Of Pennsylvania,Division Of Traumatology, Surgical Critical Care And Emergency Surgery,Philadelphia, PA, USA 3University Of Pennsylvania,School Of Nursing,Philadelphia, PA, USA 4Emory University School Of Medicine,Department Of Surgery,Atlanta, GA, USA
Introduction: Each year, over 70,000 individuals sustain non-fatal gunshot wounds and retained bullets are common after firearm injuries. We sought to qualitatively determine the signi?cance and impact of retained bullets on survivors of firearm injury. Our primary study objectives were: (1) to determine survivor desire for bullet extraction and; (2) to determine the effects of retained bullets on psychosocial health.
Methods: Nine subjects, age 18 years and older, with clinically or radiographically confirmed retained bullet fragments participated in semi-structured interviews. The encounters were transcribed and imported into NVivo 11 for analysis. Independent coders systematically reviewed all transcripts and performed concept analysis to determine themes based on interview responses using Grounded Theory methodology. Themes and subthemes were coalesced to provide a consistent framework.
Results: Overall, participants communicated a desire to have retained bullet fragments removed, however, concerns regarding removal were linked to: (1) inconvenience and uncertainty regarding the procedure; (2) concern for subsequent healing, and (3) repeated appointments and exposure to the health care system. Of note, the few victims who did have the bullet removed at a later date expressed extreme relief. There were a variety of effects of retained bullets on the patient’s physical and psychosocial health. Themes that emerged included: (1) impact of retained bullets on daily life; (2) psychological stress and emotions; (3) physical pain and awareness, and; (4) medical care experience.
Conclusion: Data revealed retained bullets significantly impact survivors of firearm injury. While the long-term psychological ramifications related to retained bullets remains unknown, this study lays the foundation for universal guidelines for bullet extraction and management. In addition, survivor narratives should inform appropriate allocation of mental health resources in this vulnerable patient population.
