The impact of X-rays was assessed with regard to how it affected the trauma surgeons' categorization. A total of 78 patients were seen with a total of 120 bullet tracts. We conclude that bullet tracts on the torso result in a subcutaneously palpable bullet one-third of the time, much more frequently than in other body regions.
Paramedics only detect one-third of subcutaneously palpable missiles on the torso.
X-rays change the categorization of bullet tracts infrequently. We recommend that a careful examination of the skin of the torso to detect palpable missiles be incorporated into the secondary survey of patients with wounds to that body region. Patients whose bullet tracts are correctly categorized early on will likely have their injuries more expeditiously diagnosed and treated than those who do not. For hemodynamically stable patients, this may have little impact. However, for unstable patients in whom a leisurely workup including extensive X-rays may be precluded, correct understanding of how a bullet tract terminates could mean the difference between rapid and delayed control of hemorrhage or relief or tamponade.