THE EFFECTS OF RETAINED LEAD BULLETS ON BODY LEAD BURDEN

许多案例报告表明，火器伤后遗留的铅射弹可能导致铅中毒，并可能造成致命后果。 为了评估遗留的射弹对随后铅暴露的影响，不能依赖于自我选择的表现出铅中毒症状的病例。 该项目的长期目标是减少因火器伤遗留子弹而导致的与身体铅负荷相关的发病率。 拟议的调查旨在确定留有铅子弹的个人血铅水平升高的风险因素，建立适当的铅测试方案，制定取出子弹的指征，并为未取出的碎片的适当管理提供指导方针。该研究设计包括随访300名在大型公立1级创伤中心接受火器伤急性治疗的留有铅子弹/子弹碎片的患者。 在患者稳定后尽快测量基线血液水平，并以3、6和12个月的间隔重复。 记录有关先前火器伤害和其他遗留射弹的病史，沿着进行筛查和风险因素问卷调查，以确定患者可能已经或目前接触的其他铅源（职业/娱乐）。 患者将进行胫骨和跟骨骨铅的K-壳层X射线荧光测定，以确定病史和风险因素分析仪未显示的既往铅暴露。 使用风险因子和骨铅浓度数据为每个患者就诊制作血铅水平的多变量模型。 将确定从一个3个月期间到下一个3个月期间的血铅变化（根据风险因素和骨铅浓度进行调整）是否可以通过编码位置和射弹碎片数据以及是否存在骨折进行显著预测。 将使用逻辑回归检验射弹留在体内的位置、碎裂、断裂和总时间等变量。 这将确定不同浓度（大于15 mug/dL、大于25 mug/dL、大于40 mug/dL等）铅升高的比值比。由于这些因素。 还将在一般线性模型（GML）的框架内采用重复测量设计分析数据。 主要关注的是作为碎裂位置、骨折和持续时间变量的函数的血药浓度的增加趋势。

Numerous case reports have demonstrated lead poisoning with potentially fatal consequences can result from retained lead projectiles following firearm injuries. To assess the impact of retained projectiles on subsequent lead exposure, one cannot rely on self-selected cases presenting with symptoms of lead intoxication. The long-term goal of this project is to reduce the morbidity associated with body lead burden as a result of retained bullets from firearm injuries. The proposed investigation seeks to identify risk factors of elevated blood lead levels for individuals with retained lead bullets, establish appropriate protocols for lead testing, develop indications for bullet removal and provide guidelines for the appropriate management of fragments not removed. The study design included follow-up of 300 patients with retained lead bullets/bullet fragments presenting for acute care of firearm injury at large publicly owned Level 1 Trauma Center. A baseline blood level is measured as soon after patient stabilization as possible and repeated at intervals of 3, 6 and 12 months. Medical history regarding prior firearms injuries and other retained projectiles is taken, along with a screening and risk factor questionnaire to determine other sources of lead (occupational/recreational) to which the patient might have been or at present be exposed. The patient will have K- shell X ray florescence determination of bone lead in the tibia and calcaneus in order to determine past lead exposure not revealed by medical history and risk factor questionnairer. Multivariate models of blood level are made for each patient visit using risk factor and bone lead concentration data. Determinations will be made if changes in blood lead, adjusted for risk factors and bone lead concentration, from one 3 month period to the next can be significantly predicted by the coded location and fragmentation data of projectiles and presence or absence of fractures. The variables of location, fragmentation, fracture and total time during which the projectile was retained in the body will be tested using logistic regression. This will determine odds ratios of elevated lead at various concentrations (greater than 15 mug/dL, greater than 25 mug/dL, greater than 40 mug/dL, etc.) due to these factors. Data will also be analyzed in the framework of the general linear model (GML), with a repeated measure design. Principal interest will be in increasing trend of blood level as a function of fragmentation location, fracture and duration variables.