Blood lead levels in emergency department patients with retained lead bullets and shrapnel.
OBJECTIVE
To determine whether patients with retained lead shrapnel who present to the ED have elevated whole blood lead levels (BLLs) compared with matched control patients.


METHODS
Test subjects were patients with x-ray evidence of retained lead shrapnel who presented to any of three urban EDs, and consented to inclusion in the study. BLLs were obtained from 15 ED patients, and data regarding time since injury and symptoms of plumbism were collected. Control subjects consisted of 15 ED patients, without similar lead exposure, matched for age, sex, race, and place of dwelling as determined by zip code, who also presented to any of the same three EDs.


RESULTS
The mean (+/-SD) BLL in the test subjects was 17+/-9.78 microg/dL (range 7-50 microg/dL). Time since impalement ranged from 1 to 45 years. The mean BLL in the control subjects was 7+/-3.77 microg/dL (0-16 microg/dL). This difference was statistically significant (two-tailed t-test p = 0.002).


CONCLUSIONS
In this preliminary study, the patients with retained lead shrapnel who presented to the ED had significantly elevated BLLs, compared with the matched control subjects. Chronic plumbism may be considered in patients with retained lead shrapnel, and a history should be taken to assess the presence of symptoms referable to plumbism. These patients may require long-term follow-up to assess the development of elevated blood lead level and lead toxicity.
Farrell
S E
SE
Department of Emergency Medicine, MCP-Hahnemann University of the Health Sciences, and Mercy Catholic Medical Center, Philadelphia, PA, USA.
Vandevander
P
P
Schoffstall
J M
JM
Lee
D C
DC
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005547:Foreign Bodies / Q000097:blood / Q000150:complications*; D006801:Humans; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014505:Urban Population; D014948:Wounds, Gunshot / Q000097:blood* / Q000000981:diagnostic imaging
D007854:Lead