Am J Epidemiol 2004; 159:683-692.
Copyright © 2004 by the Johns
Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Change in Blood Lead Concentration up to 1 Year after a Gunshot Wound with a Retained Bullet
1 Department of Oral and Maxillofacial Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, CA.
2 Drew Environmental Research Center, Charles R. Drew University of Medicine and Science, Los Angeles, CA.
3 Center for Research in Population Health, National Institute of Public Health, Cuernavaca, Mexico.
4 Department of Anesthesia, Charles R. Drew University of Medicine and Science, Los Angeles, CA.
5 Department of Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, CA.
6 Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY.
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 µg/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.
firearms; lead; lead poisoning; wounds and injuries; wounds, gunshot
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