From the Division of Trauma and Critical Care, LAC + USC Medical Center, Los Angeles, California.
J Trauma Acute Care Surg. 2021 Jun 1;90(6):973-979. doi: 10.1097/TA.0000000000003089.
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 are, however, 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.
A trauma registry was used to identify all patients sustaining a gunshot wound (GSW) from July 1, 2015, to June 31, 2016. After excluding deaths during the index admission, clinical demographics, injury characteristics, presence and location of RBF, management, and outcomes, were analyzed.
Overall, 344 patients were admitted for a GSW; of which 298 (86.6%) of these were nonfatal. 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 nonfatal 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 me, with a mean Injury Severity Score of 8.6 (range, 1-75). One hundred sixteen (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).
Retained bullet fragments are very common after a nonfatal 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.
Prognostic and epidemiological, level III.
对于无症状遗留弹片（RBF），目前尚无最佳管理策略的共识，RBF 导致的铅中毒的新数据已成为一个日益重要的问题。然而，关于这个问题的严重程度的数据却很少。本研究旨在通过描述 RBF 的发生率和分布来解决这个问题。
利用创伤登记处，确定 2015 年 7 月 1 日至 2016 年 6 月 31 日期间所有因枪伤（GSW）入院的患者。排除指数期死亡后，分析临床人口统计学、损伤特征、RBF 的存在和位置、处理和结局。
共有 344 名患者因 GSW 住院，其中 298 名（86.6%）为非致命性。其中，225 名（75.5%）有 RBF。在指数期住院期间，23 名（10.2%）患者完全取出了 RBF，35 名（15.6%）患者取出了部分 RBF，167 名（74.2%）患者未取出 RBF。总体而言，202 名（89.8%）非致命性 GSW 患者出院时仍有 RBF。取出 RBF 的主要指征是术中即刻可接近（n=39，67.2%）。RBF 最常见的位置是软组织（n=132，58.7%）。出院时携带 RBF 的患者中，平均年龄为 29.5 岁（范围，6.1-62.1 岁），187 名（92.6%）为男性，平均损伤严重程度评分（ISS）为 8.6（范围，1-75）。116 名（57.4%）患者接受了随访，其中 13 名（11.2%）因 RBF 相关并发症（感染[n=4]、疼痛[n=7]、骨折不愈合[n=1]和骨侵蚀[n=1]）返回，并发症的平均时间为 130.2 天（范围，11-528 天）。有 4 名（3.4%）患者因 RBF 相关并发症需要取出 RBF，取出的平均时间为 146.0 天（范围，10-534 天）。
非致命性 GSW 后遗留弹片非常常见。在指数期住院期间，只有少数被取出。只有一小部分在因并发症进行随访时被取出。随着铅中毒数据的积累，需要进一步的随访研究。
预后和流行病学，III 级。
