Journal article
Determining Trajectory to Predict Injury: The Use of X-Ray During Resuscitation in Gunshot Wounds
The Journal of surgical research, Vol.240, pp.201-205
01 Aug 2019
PMID: 30978600
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: The practice of marking gunshot wounds and obtaining X-rays (XRs) has been performed to determine the trajectory of missiles to help identify internal injuries. We hypothesized that surgeons would have poor accuracy in predicting injuries and that X-rays do not alter the clinical decision.
Methods: We developed a 50-patient (89 injury sites) PowerPoint survey based on cases seen at our level 1 trauma center from 2012 to 2014. Images of a silhouetted BodyMan (BM) with wounds marked, XRs, and vital signs (VSs) were shown in series for 20 s each. Surgeons were asked to record which organs they thought could be injured and to document their clinical decision. Data were analyzed to determine the inter-rater reliability (agreement, intraclass correlation coefficient [ICC]) for each mode of clinical information (BM, XR, VS). Predicted versus actual injuries were compared using absolute agreements.
Results: Ten surgeons completed the survey. We found that no single piece of information was helpful in allowing the surgeon to accurately predict injuries. Pulmonary injury had the highest agreement among all injuries (ICC = 0.727). VSs had the highest ICC in determining the clinical plan for the patient (ICC = 0.342), whereas both BM and XR had low ICCs (0.162 and 0.183, respectively).
Conclusions: We found that marking wounds and obtaining X-rays, other than a chest X-ray, did not result in accuracy in predicting injury nor alter the clinical decision. VSs were the only piece of information found significant in determining clinical management. We conclude that marking wounds for X-rays is an unnecessary step during the initial resuscitation of patients with gunshot wounds. (C) 2019 Elsevier Inc. All rights reserved.
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Details
- Title
- Determining Trajectory to Predict Injury: The Use of X-Ray During Resuscitation in Gunshot Wounds
- Creators
- Anna Goldenberg - Cooper University HospitalJeremy Badach - Cooper University HospitalChirag Arya - Cooper Medical School of Rowan UniversityJanika San Roman - Cooper University HospitalJohn Gaughan - Cooper University HospitalJoshua P. Hazelton - Cooper University Hospital
- Publication Details
- The Journal of surgical research, Vol.240, pp.201-205
- Publisher
- Elsevier
- Number of pages
- 5
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000468740900023
- Scopus ID
- 2-s2.0-85063941697
- Other Identifier
- 991022057018704721
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- Web of Science research areas
- Surgery