BACKGROUND: During 2003–2012, 145,811 persons aged ≥16 years in 41 states were reported with blood lead levels (BLLs) ≥10 µg/dL through the national Adult Blood Lead Epidemiology and Surveillance (ABLES) program. Regular BLL screening occurs when occupational lead exposure is likely. Retained bullets are a less-recognized potential source of lead exposure. Gunshot wounds are a major health issue in the United States causing over 117,000 fatal and nonfatal injuries per year; bullet removal is not routinely indicated in emergency departments. Nonspecific symptoms related to elevated BLLs can appear years after acquiring a retained bullet. We analyzed reported elevated BLL (BLL ≥10 µg/dL) cases attributable to retained bullets to help assess the public health burden of lead exposure because of retained bullets.
METHODS: We analyzed 2003–2012 national ABLES data for persons aged ≥16 years. A retained bullet case was defined as a BLL ≥10 µg/dL attributable to retained bullet fragments as determined through interview. Only an individual’s highest BLL was included in analyses.
RESULTS: During 2003–2012, 457 retained bullet cases were identified via ABLES, with a maximum BLL of 306 µg/dL (median: 21 µg/dL). Age range was 16–87 years (median: 29 years); 42.7% (195) occurred among persons aged 16–24 years; 83.2% (380) occurred among males. Exposure source was classified as nonoccupational for 94.1%. Retained bullet cases accounted for 0.3% of all elevated BLLs, but 7.5% of BLLs ≥100 ug/dL.
CONCLUSIONS: Persons with retained bullets should receive baseline and periodic BLL tests; elevated BLL patients with unknown exposure source should be asked about retained bullets. To prevent chronic lead exposures, the medical community should consider bullet and fragment removal upon presentation.