Emory University School of Medicine, Atlanta, GA, USA.
Carolinas HealthCare System Pineville, Charlotte, NC, USA.
J Interpers Violence. 2022 Jan;37(1-2):NP306-NP326. doi: 10.1177/0886260520914557. Epub 2020 May 5.
Retained bullets are common after firearm injuries, yet their management remains poorly defined. Surgeon members of the Eastern Association for the Surgery of Trauma ( = 427) were surveyed using an anonymous, web-based questionnaire during Spring 2016. Indications for bullet removal and practice patterns surrounding this theme were queried. Also, habits around screening and diagnosing psychological illness in victims of firearm injury were asked. Most respondents were male (76.5%, 327) and practiced at urban (84.3%, 360), academic (88.3%, 377), Level 1 trauma centers (72.8%, 311). Only 14.5% ( 62) of surgeons had institutional policies for bullet removal and 5.6% ( 24) were likely to remove bullets. Half of the surgeons (52.0%, 222) preferred to remove bullets after the index hospitalization and pain (88.1%, 376) and a palpable bullet (71.2%, 304) were the most frequent indications for removal. Having the opportunity to follow-up with patients to discuss bullet removal was significantly predictive of removal (odds ratio (OR) = 2.25, 95% confidence interval (CI) = [1.05, 4.85], .04). Furthermore, routinely asking about retained bullets during outpatient follow-up was predictive of new psychological illness screening (OR = 1.94, 95% CI [1.19, 3.16], .01) and diagnosis (OR = 1.86, 95% CI = [1.12, 3.09], .02) in victims of firearm injury. Thus, surgeons should be encouraged to allot time for patients concerning retained bullet management so that a shared decision can be reached.
在火器伤后，弹丸残留较为常见，但它们的处理方法仍未得到明确界定。2016 年春季，东部创伤外科学会（Eastern Association for the Surgery of Trauma，EAST）的外科医生成员接受了一项匿名的网络问卷调查，调查内容涉及弹丸取出的适应证以及这方面的实践模式，同时还询问了在火器伤受害者中筛查和诊断心理疾病的习惯。大多数受访者为男性（76.5%，327 人），工作于城市（84.3%，360 人）、学术（88.3%，377 人）和一级创伤中心（72.8%，311 人）。只有 14.5%（62 人）的外科医生有弹丸取出的机构政策，5.6%（24 人）可能会取出弹丸。一半的外科医生（52.0%，222 人）更愿意在索引住院期间及出现疼痛（88.1%，376 人）和可触及弹丸（71.2%，304 人）时取出弹丸。有机会与患者一起讨论弹丸取出的问题，这与取出弹丸显著相关（比值比（odds ratio，OR）=2.25，95%置信区间（confidence interval，CI）= [1.05, 4.85]，.04）。此外，在门诊随访期间常规询问患者是否遗留弹丸，与新的心理疾病筛查（OR=1.94，95%CI [1.19, 3.16]，.01）和诊断（OR=1.86，95%CI= [1.12, 3.09]，.02）显著相关。因此，应该鼓励外科医生为患者留出时间来管理遗留弹丸，以便做出共同决策。
