Abstract Objectives: To determine the prevalence of elevated blood lead levels and to evaluate the accuracy of a lead screening questionnaire in a western United States urban inner-city pediatric population. Design: A convenience sample of children between the ages of 6 months and 6 years seen for a well-child visit were enrolled. Venous blood lead levels were measured and a lead screening questionnaire was completed. Setting: The primary care clinics of the 10 community health centers of the city and county of Denver, Colorado. Approximately 85% of children receiving services are below the 150% poverty level and 54% are insured through the state's Medicaid program. Subjects: A total of 2978 children seen for a well-child visit from February 1993 to January 1994. Main Outcome Measures: The prevalence of elevated blood lead levels and the operating characteristics of both the Centers for Disease Control and Prevention lead screening questionnaire and the complete questionnaire used in Denver, using venous blood lead levels as the criterion standard. Results: The mean blood lead level was 0.20 μmol/L (4.19 μg/dL). Eighty-five children had blood lead levels of 0.48 μmol/L (10 μg/dL), representing 2.9% of the study group (95% confidence interval [CI], 2.3-3.5). Only 0.3% of the cohort had blood lead levels greater than 0.96 μmol/L (20 μg/dL). The sensitivity, specificity, and positive predictive value of the Centers for Disease Control and Prevention questionnaire was 57%, 51%, and 3%, respectively. The sensitivity, specificity, and positive predictive value of the complete questionnaire was 59.7%, 36%, and 2.6%, respectively. The marginal cost of identifying a child with a blood lead level greater than 0.96 μmol/L (20 μg/dL) was $4925. Conclusions: Few of the low-income children in this study had blood lead levels greater than 0.48 μmol/L (10 μg/dL). The questionnaire did little better than chance at predicting the presence or absence of elevated blood lead levels and cannot replace a blood lead level test for childhood lead screening in this community.Arch Pediatr Adolesc Med. 1996;150:958-963 References 1. Pirkle JL, Brody DJ, Gunter EW, et al. The decline in blood lead levels in the United States: the National Health and Nutrition Examination Surveys (NHANES) . JAMA . 1994;272:284-291.Crossref 2. American Academy of Pediatrics Committee on Environmental Health. Lead poisoning: from screening to primary prevention . Pediatrics . 1993;92:176-183. 3. Brody DJ, Pirkle JL, Kramer RA, et al. Blood lead levels in the US population: phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991) . JAMA . 1994;272:277-283.Crossref 4. Centers for Disease Control. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services; 1991. 5. Schaffer SJ, Szilagyi PG, Weitzman M. Lead poisoning risk determination in an urban population through the use of a standardized questionnaire . Pediatrics . 1994;93:159-163. 6. Binns HJ, LeBailly S, Poncher J, Kinsella T, Saunders S. Is there lead in the suburbs? risk assessment in Chicago suburban pediatric practices . Pediatrics . 1994;93:164-171. 7. Rooney BL, Hayes EB, Allen BK, Strutt PJ. Development of a screening tool for prediction of children at risk for lead exposure in a midwestern clinical setting . Pediatrics . 1994;93:183-187. 8. Tejeda DM, Wyatt DD, Rostek BR, Solomon WB. Do questions about lead exposure predict elevated lead levels? Pediatrics . 1994;93:192-194. 9. Nordin JD, Rolnick SJ, Griffin JM. Prevalence of excess lead absorption and associated risk factors in children enrolled in a midwestern health maintenance organization . Pediatrics . 1994;93:172-177. 10. Striph KB. Prevalence of lead poisoning in a suburban practice . J Fam Pract . 1995;41:65-71. 11. Gellert GA, Wagner GA, Maxwell RM, Moore D, Foster L. Lead poisoning among low-income children in Orange County, California . JAMA . 1993;270:69-71.Crossref 12. Childhood lead poisoning surveillance, San Francisco, 1991 . Epidemiol Bull . 1992;9:9-14. 13. Blatt SD, Weinberger HL. Prevalence of lead exposure in a clinic using 1991 Centers for Disease Control and Prevention recommendations . AJDC . 1993; 147:761-763. 14. Fleiss JL. Statistical Methods for Rates and Proportions . New York, NY; Wiley & Sons: 1981.
Archives of Pediatrics & Adolescent Medicine – American Medical Association
Published: Sep 1, 1996