Hafertepen Stephen C, Davis James W, Townsend Ricard N, Sue Lawrence P, Kaups Krista L, Cagle Kathleen M
Department of Surgery, Fresno Medical Education Program University of California San Francisco, 1st Floor, 2823 Fresno Street, Fresno, CA, 93721, USA,
World J Surg. 2015 Jul;39(7):1840-7. doi: 10.1007/s00268-015-3004-x.
Poorly designed experiments and popular media have led to multiple myths about wound ballistics. Some of these myths have been incorporated into the trauma literature as fact and are included in Advanced Trauma Life Support (ATLS). We hypothesized that these erroneous beliefs would be prevalent, even among those providing care for patients with gunshot wounds (GSWs), but could be addressed through education.
ATLS course content was reviewed. Several myths involving wound ballistics were identified. Clinically relevant myths were chosen including wounding mechanism, lead poisoning, debridement, and antibiotic use. Subsequently, surgery and emergency medicine services at three different trauma centers were studied. All three sites were busy, urban trauma centers with a significant amount of penetrating trauma. A pre-test was administered prior to a lecture on wound ballistics followed by a post-test. Pre- and post-test scores were compared and correlated with demographic data including ATLS course completion, firearm/ballistics experience, and years of post-graduate medical experience (PGME).
One-hundred and fifteen clinicians participated in the study. A mean pre-test score of 34 % improved to 78 % on the post-test with associated improvements in all areas of knowledge (p < 0.001). Years of PGME correlated with higher pre-test score (p = 0.021); however, ATLS status did not (p = 0.774).
Erroneous beliefs involving wound ballistics are prevalent even among clinicians who frequently treat victims of GSWs and could lead to inappropriate treatment. Focused education markedly improved knowledge. The ATLS course and manual promulgate some of these myths and should be revised.
设计欠佳的实验和大众媒体催生了多个关于伤口弹道学的错误观念。其中一些错误观念已作为事实被纳入创伤文献，并包含在高级创伤生命支持（ATLS）中。我们推测，即使在为枪伤（GSW）患者提供护理的人员中，这些错误观念也很普遍，但可以通过教育加以纠正。
对ATLS课程内容进行了审查。识别出了几个涉及伤口弹道学的错误观念。选择了具有临床相关性的错误观念，包括致伤机制、铅中毒、清创和抗生素使用。随后，对三个不同创伤中心的外科和急诊科进行了研究。所有三个地点都是繁忙的城市创伤中心，有大量穿透性创伤病例。在关于伤口弹道学的讲座前进行了预测试，讲座后进行了后测试。比较了预测试和后测试的分数，并将其与人口统计学数据相关联，包括ATLS课程完成情况、火器/弹道学经验以及毕业后医学经验（PGME）年限。
115名临床医生参与了该研究。预测试的平均分数为34%，后测试时提高到了78%，所有知识领域都有相关改善（p<0.001）。PGME年限与较高的预测试分数相关（p = 0.021）；然而，ATLS状态与预测试分数无关（p = 0.774）。
即使在经常治疗GSW受害者的临床医生中，涉及伤口弹道学的错误观念也很普遍，可能导致不适当的治疗。针对性的教育显著提高了知识水平。ATLS课程和手册传播了其中一些错误观念，应予以修订。
