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Do questions about lead exposure predict elevated lead levels?
D M Tejeda1, D D Wyatt, B R Rostek
1Department of Pediatrics, California Pacific Medical Center, San Francisco 94118.
Insights
The Centers for Disease Control and Prevention (CDC) lead poisoning questionnaire effectively screens for elevated lead levels in children. Questions about home environment factors, like chipping paint, are strong indicators of potential lead exposure.
Area of Science:
- Pediatric Environmental Health
- Public Health Surveillance
- Toxicology
Background:
- Lead poisoning remains a significant public health concern, particularly in young children.
- Early identification of elevated lead levels is crucial to prevent long-term health effects.
- Screening tools are essential for identifying at-risk children in clinical settings.
Purpose of the Study:
- To evaluate the effectiveness of the Centers for Disease Control and Prevention (CDC) lead poisoning questionnaire as a screening tool.
- To determine the sensitivity and specificity of specific questionnaire items for detecting elevated blood lead levels.
- To assess the overall utility of the CDC questionnaire in a general pediatric population.
Main Methods:
- A descriptive study was conducted in a pediatric clinic and private practices.
- Venous blood lead levels were measured in 485 children aged 9 months to 6 years.
- A five-question CDC questionnaire was administered to primary caretakers of 330 children, and responses were compared with lead levels.
Main Results:
- Elevated lead levels (≥10 µg/dL) were found in 7% of children.
- Positive responses regarding chipping paint and home remodeling were significantly associated with elevated lead levels (P = .0001).
- Questions about the home environment demonstrated high sensitivity (70-74%) and negative predictive values (97-98%) for detecting elevated lead levels.
Conclusions:
- The CDC lead poisoning questionnaire is an effective screening tool for identifying children with elevated lead levels in this population.
- Questions focusing on the home environment (chipping paint, remodeling) are more sensitive indicators of elevated lead levels than traditional risk factors.
- The questionnaire, particularly when considering the CDC's high-risk definition, offers high sensitivity and negative predictive value for lead poisoning screening.
Objective:
To assess the usefulness of the lead poisoning questionnaire developed by the Centers for Disease Control and Prevention as a screening tool for elevated lead levels.
Methods:
This descriptive study used a five-question questionnaire at our hospital-based general pediatric clinic and in two local private practices. We obtained venous lead levels from 485 children aged 9 months to 6 years who were brought for health supervision visits. The questionnaire was completed by a primary caretaker of 330 patients (68%). Contingency tables were used to compare lead levels with the responses on the questionnaire.
Results:
Lead levels of > or = 10 micrograms/dL were found in 23 (7%) of 330 who completed the questionnaire. Caretakers of children with elevated lead levels were more likely to answer yes to questions about chipping paint and home remodeling than those whose children had levels < 10 (P = .0001). These questions had sensitivities for detecting elevated lead levels of 70% and 74% with negative predictive values of 97% and 98%, respectively. Questions about known contacts with lead poisoning and job or industrial exposure to lead each had sensitivities of < 10%. The Centers for Disease Control and Prevention's definition of high risk for lead poisoning (one or more positive responses) was nearly 90% sensitive for detecting elevated lead levels with a negative predictive value of 99%.
Conclusion:
This risk assessment questionnaire is an effective screening method for elevated lead levels in our population. Questions about the home environment were more sensitive indicators of elevated lead levels than other standard high-risk questions.