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CDC'S SURVEY FAILS TO IDENTIFY LEAD EXPOSURE.

The Centers for Disease Control and Prevention (CDC) recommends screening young children at high risk for lead exposure more frequently than those at low risk. To identify these children, the CDC developed a five-question survey on risk factors for lead exposure; this instrument has been studied previously with variable results (see Journal Watch accession number 950804004 and J Fam Pract 1995; 41:65; and Journal Watch accession number 950915007 and MMWR 1995; 44:627).

In this study, investigators evaluated the questionnaire and venous blood samples from 463 children living in Lawrence, MA, a city with a high risk for lead exposure. Only one risk factor -- having a sibling, housemate, or playmate who had been treated or followed up for lead poisoning -- was significantly associated with an elevated blood lead concentration. Although 69 percent of all respondents had at least one positive answer, they were no more likely to have elevated blood lead concentrations than children who had responded negatively to all five questions. In addition, the authors developed a survey of behavioral risk factors for elevated blood lead levels, which was also of little value in identifying the target group. Of the nine behaviors surveyed, only two reached significance: using a pacifier and playing within one yard of the outside of the house.

Comment: The poor sensitivity and specificity of both the CDC's questionnaire and the behavioral risk survey suggest they should be abandoned as screening tools in favor of universal screening in high-risk communities, according to the same schedule.

— RA Dershewitz

Published in Journal Watch General Medicine March 5, 1996

Citation(s):

Dalton MA et al. Utility of a risk assessment questionnaire in identifying children with lead exposure. Arch Pediatr Adolesc Med 1996 Feb 150 197-202.

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