Journal Article

Change in Blood Lead Concentration up to 1 Year after a Gunshot Wound with a Retained Bullet

Joseph L. McQuirter, Stephen J. Rothenberg, Gracie A. Dinkins, Vladislav Kondrashov, Mario Manalo and Andrew C. Todd

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 159, issue 7, pages 683-692
Published in print April 2004 | ISSN: 0002-9262
Published online April 2004 | e-ISSN: 1476-6256 | DOI:
Change in Blood Lead Concentration up to 1 Year after a Gunshot Wound with a Retained Bullet

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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.

Keywords: firearms; lead; lead poisoning; wounds and injuries; wounds, gunshot

Journal Article.  6700 words.  Illustrated.

Subjects: Public Health and Epidemiology

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