Citation

Nee N, Inaba K, Schellenberg M, Benjamin E, Lam L, Matsushima K, Strumwasser A, Demetriades D. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003089

PMID

unavailable

Abstract

BACKGROUND: With no consensus on the optimal management strategy for asymptomatic retained bullet fragments (RBF), the emerging data on RBF lead toxicity have become an increasingly important issue. There however are a paucity of data on the magnitude of this problem. The aim of this study was to address this by characterizing the incidence and distribution of RBF.

METHODS: A trauma registry was utilized to identify all patients sustaining a GSW from 7/01/2015 - 6/31/2016. After excluding deaths during the index admission, clinical demographics, injury characteristics, presence and location of RBF, management, and outcomes, were analyzed.

RESULTS: Overall, 344 patients were admitted for a GSW; of which 298 (86.6%) of these were non-fatal. Of these, 225 (75.5%) had an RBF. During the index admission, 23 (10.2%) had complete RBF removal, 35 (15.6%) had partial, and 167 (74.2%) had no removal. Overall, 202 (89.8%) patients with non-fatal GSW were discharged with an RBF. The primary indication for RBF removal was immediate intraoperative accessibility (n=39, 67.2%). The most common location for an RBF was in the soft tissue (n= 132, 58.7%). Of the patients discharged with an RBF, mean age was 29.5 years, (range, 6.1 - 62.1 years), 187 (92.6%) were male, with a mean ISS 8.6 (range, 1 - 75). 116 (57.4%) received follow-up and of these, 13 (11.2%) returned with an RBF related complication [infection (n=4), pain (n=7), fracture nonunion (n=1) and bone erosion (n=1)], with a mean time to complication of 130.2 days (range, 11 - 528 days). Four (3.4%) required RBF removal with a mean time to removal of 146.0 days (range, 10 - 534 days).

CONCLUSIONS: RBFs are very common after a non-fatal GSW. During the index admission, only a minority are removed. Only a fraction of these are removed during follow up for complications. As lead toxicity data accumulates, further follow-up studies are warranted.

LEVEL OF EVIDENCE: Level III, Prognostic and Epidemiological.

Language: en