Retained Bullets After Firearm Injury: A Survey on Surgeon Practice Patterns

Area of Science:

• Trauma Surgery
• Firearm Injury Management
• Surgical Practice Patterns

Background:

• Retained bullets are a common sequela of firearm injuries.
• Current management strategies for retained bullets are not well-defined.
• Psychological impact on firearm injury victims requires attention.

Purpose of the Study:

• To survey trauma surgeons regarding their practices and indications for retained bullet removal.
• To investigate the association between follow-up practices and bullet removal rates.
• To explore the relationship between retained bullet discussions and psychological screening in firearm injury survivors.

Main Methods:

• Anonymous web-based survey distributed to 427 surgeon members of the Eastern Association for the Surgery of Trauma in Spring 2016.
• Questions focused on indications for bullet removal, practice patterns, and psychological screening habits.
• Statistical analysis included odds ratios to determine predictive factors for bullet removal and psychological screening.

Main Results:

• Only 14.5% of surgeons reported institutional policies for bullet removal, and 5.6% were likely to remove bullets.
• Pain (88.1%) and palpable bullet (71.2%) were primary indications for removal, often deferred post-hospitalization (52.0%).
• Follow-up opportunities significantly predicted bullet removal (OR=2.25, p=.04) and psychological screening/diagnosis (OR=1.94, p=.01 and OR=1.86, p=.02, respectively).

Conclusions:

• Surgeons' practices regarding retained bullet management are variable and lack standardized institutional policies.
• Dedicated follow-up time for discussing retained bullet management is crucial for shared decision-making and improved patient care.
• Routine outpatient follow-up regarding retained bullets may enhance psychological screening and diagnosis in firearm injury victims.