Change in blood lead concentration up to 1 year after a gunshot wound with a retained bullet.
The authors studied the time course and prevalence of elevated blood lead concentrations and associated injury- and patient-specific factors during the first year following gunshot injury. They determined blood lead levels at mean time points of 0.3, 3.1, 18.7, 94.5, 188.3, and 349.4 days after injury in a volunteer sample of 451 subjects from a Los Angeles, California, trauma center who sustained a first-time gunshot injury with a retained projectile in 2000-2002. In mixed-model analyses, blood lead levels increased with time postinjury (p < 0.0005) up to 3 months, with number of retained fragments (p < 0.0005), and with increasing age (p < 0.0005). Increased blood lead concentration as a function of fragmentation was approximately 30% higher among subjects who had suffered bone fracture in the torso (p < 0.0005). Subjects with bullets or fragments lodged near bone (p < 0.0005) or near joints (p = 0.032) had higher blood lead levels. Logistic models correctly predicted a blood lead elevation of >/=20 micro g/dl in 81% and 85% of subjects at 3 and 6 months postinjury, respectively. The prevalence of elevated blood lead was 11.8% at 3 months and 2.6% at 12 months. The authors recommend continued surveillance of blood lead levels after gunshot injury for patients with key indicators.
McQuirter
Joseph L
JL
Department of Oral and Maxillofacial Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
Rothenberg
Stephen J
SJ
Dinkins
Gracie A
GA
Kondrashov
Vladislav
V
Manalo
Mario
M
Todd
Andrew C
AC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001822:Body Burden; D002111:Calcaneus / Q000378:metabolism; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000097:blood* / Q000150:complications*; D006801:Humans; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013977:Tibia / Q000378:metabolism; D013997:Time Factors; D014948:Wounds, Gunshot / Q000097:blood*
D007854:Lead