ASSESSING EXPOSURE FROM RETAINED EMBEDDED METAL FRAGMENTS: FINDINGS FROM THE VA’S TOXIC EMBEDDED FRAGMENT REGISTRY

In 2008, the VA established the Toxic Embedded Fragment Surveillance Center and Registry in response to a large number of blast injuries related to improvised explosive devices (IEDs) in Iraq and Afghanistan. Blast injuries can lead to multiple retained fragments of unknown composition in soldiers. Evidence suggests that embedded metal fragments in the body can pose significant local and systemic health effects, thus warranting the need for medical surveillance of this population of Veterans to determine fragment-related exposure and potential long-term health effects. As part of the VA’s medical surveillance program, fragments removed from Veterans are analyzed for composition and urine biomonitoring is used to gain insight into the composition of fragments that remain in the body. This presentation will summarize current findings to date, including urine biomonitoring results from over 500 Veterans, and discuss how information captured in the Embedded Fragment Registry will be used to help develop medical and surgical management guidelines to determine when removal of embedded fragments is warranted. Supported by the Department of Veterans Affairs and approved by the Baltimore VA Medical Center’s Office of Research and Development and University of Maryland’s School of Medicine Institutional Review Board.