Myths and Misinformation About Gunshot Wounds may Adversely Affect Proper Treatment.

BACKGROUND: 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. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.

Isolated free fluid on abdominal computed tomography in blunt trauma: watch and wait or operate?

BACKGROUND: Isolated free fluid (FF) on abdominal CT in stable blunt trauma patients can indicate the presence of hollow viscus injury. No criteria exist to differentiate treatment by operative exploration vs observation. The goals of this study were to determine the incidence of isolated FF and to identify factors that discriminate between patients who should undergo operative exploration vs observation. STUDY DESIGN: A review of blunt trauma patients at a Level I trauma center from July 2009 to March 2012 was performed. Patients with a CT showing isolated FF after blunt trauma were included. Data collected included demographics, injury severity, physical examination, CT, and operative findings. RESULTS: Two thousand eight hundred and ninety-nine patients had CT scans, 156 (5.4%) of whom had isolated FF. The therapeutic operative group included 13 patients; 9 had immediate operation and 4 failed nonoperative management. The nonoperative/nontherapeutic operation group consisted of 142 patients with successful nonoperative management and 1 patient with a nontherapeutic operation. Abdominal tenderness was documented in 69% of the therapeutic operative group and 23% of the nonoperative/nontherapeutic group (odds ratio = 7.5; p < 0.001). The presence of a moderate to large amount of FF was increased in the therapeutic operative group (85% vs 8%; odds ratio = 66; p < 0.001). CONCLUSIONS: Isolated FF was noted in 5.4% of stable blunt trauma patients. Blunt trauma patients with moderate to large amounts of FF without solid organ injury on CT and abdominal tenderness should undergo immediate operative exploration. Patients with neither of these findings can be safely observed.