Lead screening in the general pediatric clinic

The overall prevalence of an elevated lead level in the UVa pediatric clinic population (5.7%, > or = 10 micrograms/dL; 1.1%, > or = 15 micrograms/dL) was lower than that reported by Bronson and Renier (Duluth, Minnesota) (8.2%, > or = 10 micrograms/dL, and 2.6%, > or = 15 micrograms/dL), Pirkle and colleagues (National Health and Nutrition Examination Survey III (9.0%, > or = 10 micrograms/dL) and Norman and associates (North Carolina) (20.2%, > or = 10 micrograms/dL; 3.2%, > or = 15 micrograms/dL; 1.1%, > or = 20 micrograms/dL). The results are similar to those reported by the city of Denver (3% and 1%, respectively). None of the children had a level > or = 25 micrograms/dL, a level found in 2.1/1000 children in Massachusetts, or a level > or = 45 micrograms/dL, the level recommended for chelation therapy in asymptomatic children. In view of the base cost of universal lead screening ($33/test) in the UVa laboratories and the lack of an increased prevalence of lead poisoning in the children in the UVa clinic, clinic personnel favor screening only those children who have a positive response to any of the risk assessment questions, but in particular, the question "does your child live in or visit frequently a house built before 1960?"