S. A. Eidelson1, C. A. Karcutskie1, A. B. Padiadpu1, M. B. Mulder1, S. K. Madiraju1, G. D. Garcia1, G. D. Pust1, N. Namias1, C. I. Schulman1, K. G. Proctor1 1University Of Miami,Miami, FL, USA
Introduction:
On Feb 17, 2017, the CDC reported that retained bullet fragments (RBF) may be a source of elevated blood lead levels (BLL) in those with no other known exposure. This conclusion was based on voluntary reports of BLL>10 µg/dl to the CDC’s National Institute for Occupational Safety and Health. Roughly 75,000 non-fatal firearm injuries occur annually in the United States and routine screening for BLL is rarely performed. Thus, the incidence and magnitude of BLLs from RBF are unknown, but the CDC reports that any measurable BLL is unsafe. We test the hypothesis that BLLs are elevated in trauma patients with RBF.
Methods:
BLL were measured in 23 consecutive adult patients with imaging-proven RBF admitted to an American College of Surgeon’s verified level 1 trauma center from 2/15/17-7/16/17. BLL is considered elevated at >5 μg/dL. Data are expressed as mean±standard deviation if parametric and median if nonparametric. Differences are assessed at p<0.05.
Results:
The study population is 95.7% male, 33±15 yrs, 25±4 kg/m2, and 70% African American. Of twenty-three patients with RBF, 35.0% (n=8) were found to have elevated blood lead levels and 74.0% (n=17) were found to have measureable lead levels.
Conclusion:
These preliminary data provide basic proof of concept that measurable BLL occur in over half of trauma patients with RBF, regardless of days exposed. Potential deleterious effects include impaired renal function with BLL <5 μg/dL, an increased risk for hypertension and essential tremor with BLL between 5-10 μg/dL, and neurocognitive deficits and adverse reproductive outcomes (including spontaneous abortion and reduced birthweight) with BLL ≥10 μg/dL. Thus, patients with RBF may benefit from precautionary counseling on lead poisoning and the importance of baseline and periodic monitoring. Moving forward, there may also be a potential benefit of surgical retrieval.
