43 - UNDERSTANDING THE IMPACT OF RETAINED BULLETS FROM SURVIVORS OF GUNSHOT INJURY

Objectives: Despite increasing knowledge of the prevalence of retained bullet fragments (RBFs) after civilian gunshot injuries, there is limited research on the full spectrum of consequences of RBFs, particularly the psychological effects. Moreover, the experiences and perceptions of the injured are missing from existing literature. Hence, the objective of our study was to understand the impacts of RBFs on individuals who have experienced recent gunshot injuries.

Methods: Study participants were adults (18-65 years) who were survivors of gunshot injuries with radiographically-confirmed retained bullet fragments. Survivors were purposively recruited from an urban Level 1 trauma center in Atlanta, Georgia and invited to participate in a qualitative study between March 2019 and February 2020. Semi-structured in-depth interviews were conducted with 24 participants at least one month following injury. Interview topics included knowledge and life impacts of RBFs as well as coping strategies. Thematic analysis was used to iteratively identify themes, which were then categorized into four domains of impact of RBFs.

Results: The majority of survivors interviewed were male (N=21, 87.5%), Black (N=22, 91.6%) with a mean age of 31.8 years and a mean duration of exposure (time from injury to interview) of 8.6 months. Four domains of impact of RBFs emerged: 1) Physical health effects including pain, limited mobility and poor quality sleep; 2) Emotional consequences of the RBF leading to flashbacks, frustration and shame; 3) Social isolation as a result of the RBFs causing challenges in household and daily activities; and 4) Occupational barriers such as restricted work duties, interpersonal workplace conflicts, extended medical leave or job loss.

Conclusion: Survivors of gunshot injuries are severely impacted by RBFs. These impacts are far-reaching and affect daily activities and future aspirations. Results suggest the need for a more holistic approach to support the recovery of survivors with RBFs. Further, changes to clinical protocols regarding the removal of retained bullets and how patients are informed of the effects of leaving RBF in situ, are warranted.