Should We Screen for Lead Poisoning After 36 Months of Age? Experience in the Inner City

Karp, Robert J.; Abramson, Jill; Clark-Golden, Margaret; Mehta, Swati; Daniele, Rose Mary; Homel, Peter; Deutsch, Jack

doi:10.1367/1539-4409(2001)001<0256:swsflp>2.0.co;2

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…7,12,63,64 Screening is not efficient after 36 months of age unless specific high-risk factors are identified; the likelihood of a child having a blood lead concentration >10 μg/dL after 36 months of age is low. 65 These recommendations now need to be updated to conform to with our new understanding of lead toxicity. 11,12 A detailed evaluation and follow-up of children who have blood lead concentrations <10 μg/dL (<100 ppb) is now indicated.…”

Section: Testing Asymptomatic Children For Elevated Blood Lead Concenmentioning

confidence: 99%

Prevention of Childhood Lead Toxicity

Lanphear¹,

Lowry²,

Ahdoot³

et al. 2016

Pediatrics

177

140

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Blood lead concentrations have decreased dramatically in US children over the past 4 decades, but too many children still live in housing with deteriorated lead-based paint and are at risk for lead exposure with resulting lead-associated cognitive impairment and behavioral problems. Evidence continues to accrue that commonly encountered blood lead concentrations, even those below 5 µg/dL (50 ppb), impair cognition; there is no identified threshold or safe level of lead in blood. From 2007 to 2010, approximately 2.6% of preschool children in the United States had a blood lead concentration ≥5 µg/dL (≥50 ppb), which represents about 535 000 US children 1 to 5 years of age. Evidence-based guidance is available for managing increased lead exposure in children, and reducing sources of lead in the environment, including lead in housing, soil, water, and consumer products, has been shown to be cost-beneficial. Primary prevention should be the focus of policy on childhood lead toxicity.

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Section: Testing Asymptomatic Children For Elevated Blood Lead Concenmentioning

confidence: 99%

Prevention of Childhood Lead Toxicity

Lanphear¹,

Lowry²,

Ahdoot³

et al. 2016

Pediatrics

177

140

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show abstract

“…While geographic differences in lead exposure and competing priorities for resources may impact how localities decide to screen and manage childhood lead exposure [123,124], the level of variability in screening and management guidelines is surprising. Differences with regard to universal versus targeted screening are understandable as local differences in environmental exposure result in difference risk-benefit ratios.…”

Section: What This Study Addsmentioning

confidence: 99%

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development

2020

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Background: Pediatric lead exposure in the United States (U.S.) remains a preventable public health crisis. Shareable electronic clinical decision support (CDS) could improve lead screening and management. However, discrepancies between federal, state and local recommendations could present significant challenges for implementation. Methods: We identified publically available guidance on lead screening and management. We extracted definitions for elevated lead and recommendations for screening, follow-up, reporting, and management. We compared thresholds and level of obligation for management actions. Finally, we assessed the feasibility of development of shareable CDS. Results: We identified 54 guidance sources. States offered different definitions of elevated lead, and recommendations for screening, reporting, follow-up and management. Only 37 of 48 states providing guidance used the Center for Disease Control (CDC) definition for elevated lead. There were 17 distinct management actions. Guidance sources indicated an average of 5.5 management actions, but offered different criteria and levels of obligation for these actions. Despite differences, the recommendations were well-structured, actionable, and encodable, indicating shareable CDS is feasible. Conclusion: Current variability across guidance poses challenges for clinicians. Developing shareable CDS is feasible and could improve pediatric lead screening and management. Shareable CDS would need to account for local variability in guidance.

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“…As Caroline Wright has written, 'organized population screening programs [must be] designed to ensure that the benefits of screening outweigh the harms' [3]. Screening babies for hearing loss and infants for lead poisoning meets those standards [4]. I'm not sure that a population strategy serves our older patients who might have diabetes."…”

mentioning

confidence: 99%

Cost-Effectiveness in Clinical Screening

Karp

Shepelyak²

2011

AMA Journal of Ethics

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is a family practice doctor with a steady, yet varied, patient population. Practicing medicine in a small suburban community, he sees whole families ranging from newborn babies to adults well into their 80s. He prides himself on his practice of preventive medicine in particular, and, because he has such a longstanding rapport with his patients, they adhere to his counseling on healthy living and follow up regularly for annual physicals and appropriate screening tests. Among other things, Dr. Jorgensen is particularly diligent in his screening for, and treatment of, diabetes mellitus; he tests all of his patients over age 45 for diabetes and refers all of his diagnosed diabetic patients for annual ophthalmologic exams. Recently, Dr. Jorgensen began mentoring a new family practice physician, Dr. Sandkey. Dr. Sandkey completed her residency in family practice at a large, innercity academic hospital, where she attended a number of lectures on cost-effective treatment. Like Dr. Jorgensen, Dr. Sandkey has a special interest in preventive medicine and is well-versed in the current recommendations regarding diabetes screening and treatment.Because Dr. Sandkey is looking to model her practice after Dr. Jorgensen's, she has been going through old patient charts to see how Dr. Jorgensen tracks his patients' health maintenance. One day she approaches Dr. Jorgensen to discuss his screening practices: "Dr. Jorgensen, I have to ask you about how you choose your medical interventions and screenings. I read a study that indicated screening everyone age 45 and older for diabetes had minimal benefit but cost more than $500 per person on average. Why have you decided to screen this entire group of patients?" Commentary "The human condition is such that…there are many possible courses of actions and forms of life worth living, and therefore to choose between them is part of being rational or capable of moral judgment; [we] cannot avoid choice for one central reason...namely that ends collide; that one cannot have everything....The very concept of an ideal life...is not merely utopian, but incoherent." Isaiah Berlin [1] Dr. Jorgenson is imbued with a sense of obligation to his patients that transcends matters of cost. He wants to serve them well within a society that can seem frivolous

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Should We Screen for Lead Poisoning After 36 Months of Age? Experience in the Inner City

Cited by 4 publications

References 12 publications

Prevention of Childhood Lead Toxicity

Prevention of Childhood Lead Toxicity

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development

Cost-Effectiveness in Clinical Screening

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