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Lead poisoning risk determination in an urban population through the use of a standardized questionnaire
S J Schaffer1, P G Szilagyi, M Weitzman
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY.
Insights
The Centers for Disease Control and Prevention (CDC) questionnaire moderately identifies children at risk for lead poisoning. An abbreviated version may be equally effective, but improvements are needed for better sensitivity.
Area of Science:
- Pediatric Health
- Environmental Health
- Public Health Screening
Background:
- The CDC recommends a 5-item questionnaire for children aged 6-72 months to screen for lead exposure risk.
- Elevated lead levels pose significant health risks to children.
Purpose of the Study:
- To evaluate the effectiveness of the CDC questionnaire in identifying children with elevated blood lead levels.
- To compare the questionnaire's risk classification with actual blood lead measurements.
Main Methods:
- A pediatric clinic in Rochester, NY, studied 476 children (6-72 months) using the CDC questionnaire.
- Blood lead levels were measured via fingerstick and confirmed with venous samples.
- Questionnaire results were compared to blood lead levels (≥10 µg/dL or ≥15 µg/dL).
Main Results:
- 28% of children had blood lead levels ≥10 µg/dL, and 8% had levels ≥15 µg/dL.
- The questionnaire classified 56% of children as high-risk.
- The questionnaire correctly identified 70% of children with levels ≥10 µg/dL and 82% with levels ≥15 µg/dL.
Conclusions:
- The CDC questionnaire is effective in identifying children with elevated lead burdens in urban, high-risk populations.
- An abbreviated questionnaire (3 items) showed similar effectiveness.
- Further research is needed to enhance sensitivity and test the questionnaire in diverse settings.
Background:
The Centers for Disease Control and Prevention (CDC) has recommended using a five-item questionnaire at every regular office visit for all children 6 to 72 months of age to identify those at risk of high-dose exposure to lead.
Objective:
To determine how well the questionnaire identifies children with elevated lead levels.
Research Design:
Comparison of results of the questionnaire, which is intended to identify children as being low-risk or high-risk for lead poisoning, with children's blood lead levels.
Setting:
A pediatric continuity clinic located in a major teaching hospital in Rochester, NY.
Patients:
A consecutive sample of 476 children aged 6 to 72 months without a prior history of lead poisoning who were seen in the clinic in July and August 1992, and (for those aged < 36 months) or 12 months (for those aged 36 to 72 months).
Measurements And Main Results:
Fingerstick lead samples were obtained from all children, and those > or = 15 micrograms/dL (0.72 mumol/L) were confirmed by subsequent venous lead determinations. Twenty-eight percent had blood lead levels > or = 10 micrograms/dL (0.48 mumol/L), 8% had levels > or = 15 micrograms/dL (0.72 mumol/L), and 5% had lead levels > or = 20 micrograms/dL (0.96 mumol/L). According to responses on the questionnaire, 44% were initially classified as low-risk, and 43% were high-risk. In 13% risk could not be determined because one or more items on the questionnaire had not been answered or were answered equivocally, whereas all other items were answered "No." Children for whom risk could not be determined were presumed to be at high risk and were added to that category, resulting in 56% of the study population so designated. The questionnaire was moderately effective in identifying children with elevated lead levels. Seventy percent of children having lead levels > or = 10 micrograms/dL (0.48 mumol/L) and 82% of children having lead levels > or = 15 micrograms/dL (0.72 mumol/L) had been classified as high-risk by the questionnaire. Children classified as low-risk were very unlikely to have elevated lead levels. Eighty-one percent of low-risk children had lead levels < 10 ug/dL, and 97% had lead levels < 15 ul/dL. An abbreviated questionnaire using only the first three items from the CDC questionnaire had almost identical effectiveness.
Conclusions:
In this clinical setting, in which children are largely urban, poor, and have a moderate to high risk of developing elevated lead levels, the CDC risk assessment questionnaire is effective in identifying children with elevated lead burdens. However, an abbreviated version of the questionnaire may be as effective as the complete questionnaire. Additional questions should be added to the questionnaire to improve its overall sensitivity, and the questionnaire should be tested in other settings to see if it is effective with children having different environmental exposures to lead.