Treatment Outcome of Retained Bullet After Gunshot Wounds in a Resource-limited Setting: A Retrospective Study

A retrospective study was conducted at Al-Nasar Hospital in Ibb, Yemen, on 103 patients with retained gunshot injuries who were brought to the emergency department between January 2004 and December 2020. The study followed the principles of the Helsinki Declaration, and Ibb University's ethics board authorized it (code number: IBBUNI.AC.YEM.2023.108). Before inclusion in this study, participants were informed about the research aims and provided signed consent. Principles treatments including patient stabilization, prophylactic antibiotics, laboratory, and radiologic investigations including radiographic x-ray, ultrasonography investigations, and computed tomography scans performed for all cases.
Inclusion criteria: All patients diagnosed with retained bullet injuries in our emergency department were included in this study.
Exclusion criteria: Patients presenting with pellet-gun, rubber-bullet, and self-inflicted injuries by firearms were excluded. Patients treated in other sentences or those who died before their hospital arrival were also excluded.
Data collection: Demographic characteristics were (age, gender, residency), the main symptom description, time between injury and hospital arrival, the season of injury (i.e., usual time, marriage ceremonies and independence days, and wartime and political rallies), physical examination findings (type, locations), time to hospital arrival, the wound of entry and exit, treatment (surgery or conservative management), surgical procedures offered, surgical findings, need for blood transfusion, hospital stay, postoperative complications, and outcome.
Outcome: The primary outcome was patient survival and postoperative complications occurrence, whereas the secondary outcome was to compare the number of patients affected according to injury seasons and mortality rates according to time to hospital arrival.
Statistical analysis: The mean ± SD was used for numerical variables, and the frequency (percentage) was used for categorical variables. For numeric data, we used the Mann-Whitney U test, and for categorical data, we used the χ2 test in conjunction with Fisher's exact test. Differences were considered statistically significant when the p-value was less than 0.05. "SPSS (IBM SPSS, version 22, Armonk, New York: IBM Corp) was used to analyze the data."

本研究针对也门伊卜省阿尔纳萨尔医院2004年1月至2020年12月期间急诊接诊的103名存留枪伤患者开展回顾性分析。本研究遵循《赫尔辛基宣言》原则，由伊卜大学伦理委员会批准（批准编号：IBBUNI.AC.YEM.2023.108）。研究纳入所有受试者前，已向其告知研究目的并获得书面知情同意。所有患者均接受规范化治疗，包括患者病情稳定处理、预防性抗菌药物应用，以及实验室检查与影像学检查，其中影像学检查涵盖X线摄影、超声检查及计算机断层扫描（Computed Tomography, CT）。

纳入标准：所有在本院急诊确诊为存留枪弹伤的患者均纳入本研究。
排除标准：因霰弹枪、橡皮子弹及自行使用枪支造成损伤的患者被排除；在其他医疗机构接受治疗者，以及入院前已死亡的患者同样予以排除。

数据收集内容涵盖人口统计学特征（年龄、性别、居住地）、主要症状描述、受伤至入院的时间间隔、受伤季节（即常规时段、婚礼庆典及独立纪念日时段，以及战时与政治集会时段）、体格检查结果（损伤类型、损伤部位）、入院至启动治疗的时间间隔、伤口出入口、治疗方式（手术治疗或保守治疗）、实施的手术操作、手术所见、输血需求、住院时长、术后并发症及转归。

结局指标：主要结局为患者生存情况及术后并发症发生情况；次要结局为按受伤季节划分的受累患者数量对比，以及按受伤至入院的时间间隔划分的死亡率对比。

统计分析方法：数值变量以均值±标准差（mean ± SD）表示，分类变量以频数（百分比）表示。对于数值型数据，采用曼-惠特尼U检验（Mann-Whitney U test）；对于分类数据，采用卡方（χ²）检验结合Fisher确切概率法（Fisher's exact test）。当P值小于0.05时，认定差异具有统计学意义。本研究采用SPSS（IBM SPSS，版本22，纽约州阿蒙克：IBM公司）完成数据分析。