Citation

Hafertepen SC, Davis JW, Townsend RN, Sue LP, Kaups KL, Cagle KM. World J. Surg. 2015; 39(7): 1840-1847.

Affiliation

Department of Surgery, Fresno Medical Education Program University of California San Francisco, 1st Floor, 2823 Fresno Street, Fresno, CA, 93721, USA, shafertepen@fresno.ucsf.edu.

Copyright

(Copyright © 2015, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00268-015-3004-x

PMID

25665679

Abstract

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.

Language: en