Abstract
BackgroundPediatric 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.MethodsWe 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.ResultsWe 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.ConclusionCurrent 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.
Highlights
Pediatric lead exposure in the United States (U.S.) remains a preventable public health crisis with farreaching consequences [1, 2]
As the Centers for Disease Control (CDC) provides funding to states for lead screening and management programs, we considered whether guidance from states receiving CDC funding provided more comprehensive screening and management recommendations [23]
Identification of Lead guidance We evaluated lead guidance documents provided by all state public health departments and counties funded by the Centers for Disease Control (CDC) [23]
Summary
Pediatric lead exposure in the United States (U.S.) remains a preventable public health crisis with farreaching consequences [1, 2]. In 2012, the CDC (along with other organizations) changed the definition for elevated lead from ≥10 μg/dL to ≥5 μg/. Recent lapses in preventive measures have exposed numerous children to elevated lead, with health consequences yet to be determined [5]. As recently as 2016, the Centers for Disease Control (CDC) estimated that 500,000 children tested positive for elevated lead [6]. Preventing pediatric lead exposure is critical, given the potential for lifelong cognitive and behavioral problems [3, 7, 8]. Pediatric lead exposure in the United States (U.S.) remains a preventable public health crisis. Discrepancies between federal, state and local recommendations could present significant challenges for implementation
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