The impact of retained bullet fragments on outcomes in patients with gunshot wounds

Andrade, Erin G.; Uberoi, Megha; Hayes, Jane; Thornton, Melissa; Kramer, Jessica B.; Punch, L

doi:10.1016/j.amjsurg.2021.05.022

Cited by 10 publications

(6 citation statements)

References 27 publications

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“…While removal is not indicated in all cases, it is reported that GSW patients who do not have the projectile extracted are at increased risk of repeat visit to the emergency department within 6 months. 122 Over a 1-year period, a trauma registry identified 344 patients who were admitted for a GSW, of which 298 were nonfatal. Of these cases, 75.5% had a retained bullet fragment.…”

Section: Retained Bullet Removalmentioning

confidence: 99%

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

Baum¹,

Baum²,

Hayward³

2022

ORR

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As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles.

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Section: Retained Bullet Removalmentioning

confidence: 99%

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

Baum¹,

Baum²,

Hayward³

2022

ORR

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“…A recent study found that 26% of patients discharged from 1 large academic institution with a bullet injury presented back to the ED within 1 year with a complaint related to the injury, most often from pain or drainage/bleeding from the wound. 4 By initiating care within the first few days of injury, the BRIC will likely be able to reduce unplanned return visits to the ED. We have also created a Patient Advisory Board and hope that the patterns of experience observed among survivors at the BRIC may also influence clinical care more broadly.…”

Section: How Will This Affect Clinical Care?mentioning

confidence: 99%

The Bullet Related Injury Clinic—Healing the Deep Wounds of Gun Violence

Hayes

Hann²,

Punch³

2022

JAMA Surg

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“…3 Our prior work found that 26% of patients discharged from our ED return within 12 months with a chief complaint most frequently related to pain or wound concerns. 8 Given this high return rate, we investigated the anticipatory guidance and clinical resources that BRI patients receive on discharge from our institution.…”

Section: Introductionmentioning

confidence: 99%

Care of Bullet-related Injuries: A Cross-sectional Study of Instructions and Prescriptions Provided on Discharge from the Emergency Department

Hayes

Punch

Mueller

2023

WestJEM

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Introduction: There are more than 80,000 emergency department (ED) visits for non-fatal bullet- related injuries (BRI) per year in the United States. Approximately half of these patients are discharged home from the ED. Our objective in this study was to characterize the discharge instructions, prescriptions, and follow-up plans provided to patients discharged from the ED after BRI. Methods: This was a single-center, cross-sectional study of the first 100 consecutive patients who presented to an urban, academic, Level I trauma center ED with an acute BRI beginning on January 1, 2020. We queried the electronic health record for patient demographics, insurance status, cause of injury, hospital arrival and discharge timestamps, discharge prescriptions, and documented instructions regarding wound care, pain management, and follow-up plans. We analyzed data using descriptive statistics and chi-square tests. Results: During the study period, 100 patients presented to the ED with an acute firearm injury. Patients were predominantly young (median age 29, interquartile range 23-38 years), male (86%), Black (85%), non-Hispanic (98%), and uninsured (70%). We found that 12% of patients did not receive any type of written wound care instruction, while 37% received discharge paperwork that included instructions to take both an NSAID and acetaminophen. Fifty-one percent of patients received an opioid prescription, with a range from 3-42 tablets (median 10 tablets). The proportion of patients receiving an opioid prescription was significantly higher among White patients (77%) than among Black patients (47%). Conclusion: There is variability in prescriptions and instructions provided to survivors of bullet injuries upon ED discharge at our institution. Our data indicates that standardized discharge protocols could improve quality of care and equity in the treatment of patients who have survived a BRI. Current variable quality in discharge planning is an entry point for structural racism and disparity.

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The impact of retained bullet fragments on outcomes in patients with gunshot wounds

Cited by 10 publications

References 27 publications

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

The Bullet Related Injury Clinic—Healing the Deep Wounds of Gun Violence

Care of Bullet-related Injuries: A Cross-sectional Study of Instructions and Prescriptions Provided on Discharge from the Emergency Department

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