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Effectiveness of a pediatric verbal lead exposure screening protocol in emergency department patients
Sara Creighton1, John W Hafner, Jean C Aldag
1University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Insights
An emergency department verbal screening effectively identified children at risk for lead exposure. However, follow-up testing and documented elevated lead levels were low, indicating a need for improved referral processes.
Area of Science:
- Pediatric Emergency Medicine
- Environmental Health
- Public Health Interventions
Background:
- Urban emergency departments (EDs) serve populations at risk for elevated lead levels.
- Lead exposure poses significant health risks to children.
- Screening programs are crucial for early identification and intervention.
Purpose of the Study:
- To evaluate the effectiveness of a verbal lead screening program in urban emergency departments.
- To identify high-risk children for lead exposure.
- To assess the utility of a 6-question validated verbal survey.
Main Methods:
- Prospective observational cohort study of children aged 9 months to 6 years.
- Verbal screening survey administered to parents of eligible children in an urban ED.
- Referral to local health departments for blood lead testing for positive screens.
Main Results:
- 815 children were screened, with 25.6% screening positive.
- Most positive screens (71.8%) indicated living in pre-1978 housing.
- Only 14.8% of positively screened children had blood lead levels tested, with 4 children showing elevated levels.
Conclusions:
- ED-based verbal screening can identify children needing follow-up for lead exposure.
- Significant challenges exist in health department referral and follow-up processes.
- Improved strategies are needed to ensure adequate blood lead level testing and intervention.
Purpose:
The population demographics found in many urban emergency departments (EDs) often mirrors those of children at risk for elevated serum lead levels. We evaluated the effectiveness of a verbal lead screening program for screening high-risk children presenting to the ED.
Methods:
A prospective observational cohort study was conducted of children aged 9 months to 6 years, living in 2 target counties and presenting to an urban, academic, Midwestern ED. Those with a prior lead level, enrolled in a program requiring lead testing, or with an unstable medical condition were excluded. A 6-question validated verbal survey was administered to all parents of eligible children, and the results recorded in the patient's electronic medical record. Children who screened positive were referred to their local health department for blood lead testing. Health department records were reviewed for follow-up visits and blood lead levels.
Results:
During the study period, 3513 children were eligible (mean age, 2.6 years; 53.3% male), with 815 patients screened and 209 (25.6%) screening positive. Most positively screened patients (71.8%) documented only 1 affirmative question, most often indicating they lived in a home built before 1978. Of those children who screened positive, 14.8% (31/209) had a blood lead level performed within 6 months. Of those tested, 4 children had an elevated lead level (>10 µg/dL).
Conclusions:
Use of an ED verbal lead exposure screening tool identified children requiring additional follow-up testing. However, health department-referred children had poor follow-up, and few children were ultimately documented with elevated lead levels.
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