Screening For Blood Lead Levels Research Articles

Creativity in Health Communication to Promote Blood Lead Testing in Children.

Low rates of blood lead level screening among young children persist as a public health issue in the United States, including in Texas where levels remain below the national average. This article describes a multiyear, multipartner initiative aimed at increasing screening rates through a creative, community-informed social media campaign. Interviews with parents, providers, and state health department staff revealed a common perception that lead poisoning was a relic of the past. Using these insights, the team developed humorous social media messaging comparing extinct animals to lead poisoning to capture attention and change attitudes about lead's current relevance. The "#GetLeadCheckedTexas" campaign ran on state health department channels during National Lead Poisoning Prevention Week in October 2020. Colorful graphics depicted extinct creatures like dinosaurs along with their babies, playing on childhood enthusiasm for such animals while evoking protective feelings in parents. Messaging highlighted lead's dangers for young children and encouraged viewers to discuss testing with providers. Website analytics showed the campaign drove substantial increases in page views for lead screening resources, particularly among providers. While originally designed with a parent audience in mind, the campaign seemed to resonate more with providers, likely due to timing during an awareness week and use of official health department channels. The initiative demonstrates the value of creative communications approaches employed in traditional advertising to raise awareness and promote public health priorities. Audience research, thoughtful use of humor, and designing human-focused messaging helped cut through information clutter and drive engagement with an important childhood health issue.

B-328 Analytical Performance of a Screening Test for Lead Using Dried Blood Spots and ICP-MS

Abstract Introduction There is no safe blood lead levels (BLL) in children and exposure can cause irreversible neurological harm. In 2021, the CDC decreased the blood lead reference value (BLRV) to 3.5 ug/dL from 5.0 ug/dL, based on the 97.5th percentile of BLL among US children under 5 years of age. Despite this, lead poisoning disproportionately affects Black children, those below poverty levels, and living in houses built before 1978. The American Academy of Pediatrics recommends targeted screening for BLL in children aged 12–24 months living in high prevalence areas. Children enrolled in Medicaid also require screening by 24 months of age. Only one-third of children who require screening receive it and lead screening declined by >50% during the COVD-19 pandemic. Quality improvement strategies have included electronic health record alerts and point of care testing. To improve screening rates in our pediatric population, we developed a screening method utilizing dried blood spot (DBS) cards. This study aimed to validate the accuracy and precision of this screening method with emphasis on the performance around the BLRV cut-offs, which would be used to determine the need to follow up with a confirmatory venous lead test. Methods The method was calibrated using certified reference material traceable to NIST SRM 3128 (VHG labs, Manchester, NH, USA) in whole blood. The calibrators, controls and patient samples were spotted onto Whatman 903 cards. A 6 mm filter paper disc in extraction buffer was vortexed, allowed to sit at room temperature for 30 min and centrifuged. The samples were analyzed on the Thermo Fisher iCAP RQ and TQ (Whaltman, MA) in kinetic energy discrimination mode. The assay has a linear range of 1–100 µg/dL, and the recovery ranged from 92%–102%. We evaluated this method for reproducibility, and accuracy across the measurement range. In this study, we focused on the reproducibility and accuracy of DBS at lead concentrations around the BLRV cut-offs. We used in 2 samples spiked with NIST CRM 3128 (Inorganic Ventures, Christiansburg, VA, USA) analyzed 10 times over 3 days and 13 leftover patient samples run over at least 5 days. The total allowable error was 2 µg/dL or 10%. Results In two samples spiked to BLL of 3.5 and 3.9 µg/dL, interday precision (n = 10) ranged from 3.4% to 17.4% (SD 0.1–0.7) in samples run for 3 days. Removal of an apparent outlier decreased the %CV ranged observed to <8.5%. The average bias for each day ranged from 0.1 to 0.6 µg/dL. In 13 patient samples with concentrations around the BLRV ranging from 1.4 to 5.8 µg/dL, the coefficient of variation (CV) ranged from 0.2% to 32% with the largest SD at 0.8 µg/dL. The average bias for this sample set was -0.3 (11.7%). Conclusion The assay’s analytical performance is sufficient for screening purposes, but the clinical performance and the impact of introducing this test to enhance screening rates during 1 and 2 years well visits need to be evaluated further.

Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran: a cross-sectional study

Constipation is a common reason for children seeking medical care worldwide. Abdominal complaints and constipation are also common in lead-poisoned children. This study evaluates the prevalence of abnormal blood lead levels (BLL) among pediatric and adolescent patients and examines the association of constipation with elevated BLL. This was a prospective data collection of patients younger than 18 years old with the chief complaint of constipation seen in the Mofid Children’s Hospital gastroenterology clinic and Loghman Hakim pediatric and pediatric gastroenterology clinics were eligible for enrollment in this study. Constipation was defined as infrequent or difficult defecation according to ROME IV criteria lasting 2 months or more. BLL was measured with a fresh capillary whole blood capillary sample. The LeadCare II device assays BLL using an electrochemical technique (anodic stripping voltammetry). A total of 237 patients were enrolled in the study. 122 (51.48%) were female and 115 (48.52%) were male. About one fifth of patients (49; 20.67%) had BLL ≥ 5 µg/dL. The mean BLL in the sample was 3.51 µg/dL. Abdominal pain was the most common symptom accompanying constipation (134; 56%). Multivariate analysis found endoscopic evaluation (P values 0.024, OR 3.646, 95% CI 1.189–11.178), muscle pain (P values 0.020, OR 24.74, 95% CI 1.67–365.83), and maternal education (P values 0.02, OR 4.45, 95% CI 1.27–15.57) with significant differences in groups of patients with normal and elevated BLL. Elevated BLL necessitates an assessment and plans to reduce childhood lead exposure. BLL screening in childhood constipation with refractory chronic abdominal pain may also eradicate the need for invasive procedures like endoscopic evaluation.

The cultural dimensions of collective action during environmental hazards: Assessing race, gender, and social support network dynamics in the Flint Water Crisis

IntroductionThe water crisis in Flint, Michigan, a majority-Black, low-income city, consisted of citywide water contamination with lead (Pb) and various harmful bacteria, fracturing civic trust. Literature suggests that social networks form, or strengthen, in the absence of adequate government and institutional responses to environmental hazards. Nonetheless, little is known about how these networks are sociodemographically composed and how they may fuel collective action and drives certain health outcomes and beliefs. MethodsWe conducted surveys with Flint residents, exploring differences in network dimensions based on dynamics including respondent demographics, the length of time to the respondent becoming cognizant of potential water contamination issues, and subsequent health outcomes and beliefs. FindingsOverall, the mean network size of respondents was 3.0 (±2.0) confidants. Irrespective of gender, Black respondents were more likely to have women in their network (p = 0.01). In general, women respondents had larger networks than men (p = 0.048), and individuals eligible for public benefits (e.g., Medicaid) had larger networks than those who were ineligible (p = 0.095). Blood lead level screening was higher among individuals with more women in their network, while increasing tie strength was associated with lower odds of depression/anxiety severity (PHQ-4) and PTSD (PTSD-PC-5) symptoms. ConclusionsFindings here suggest that social networks may have been important sources of support and information during the FWC. In particular, the presence of women in residents’ social networks may have improved health promotion behaviors (screening) and lowered morbidity risks. These results highlight potential protective features of networks and the additive salience of gender following a socio-politically intricate environmental disaster.

Assessing Lead Screening Rates at a Rural Tertiary Teaching Hospital

Background: Significant adverse health outcomes in children are related to elevated blood lead levels (BLL). Exposure to lead remains a significant public health issue in the United States, yet screening rates remain low. This study assessed lead screening rates in a rural tertiary teaching hospital serving a bi-state area to determine if opportunities exist to improve care. Methods: The study performed a retrospective review of 5,016 electronic medical records for children who turned 30 months old between January 1, 2017, and December 31, 2021, and received care from ages 9 through 30 months. Chi-square tests assessed differences between groups. Logistic regression examined state-by-provider interaction. Results: No significant difference ( P = 0.734) was found between states in the first BLL completion rate. There was a statistically higher ( P < 0.001) difference between states for a second BLL test completion. In the state with a universal screening requirement, the health system was below standard but performed equivalently or better than research studies. In the state requiring only children benefiting from Medicaid to undergo screening, compliance could not be definitively established. However, proxy statistics concluded that screening rate improvements could be made. Pediatric offices were more likely to realize first and second BLL test results. State-by-provider interaction provided mixed results. Conclusion: This health care system aims to provide the highest evidence-based care to each patient, regardless of provider type or service location. The study shows opportunities exist to improve BLL screening and proposes education, electronic reminders, and in-office blood collection solutions.

Abstract P104: High Lead Levels Associated With Elevated Blood Pressure In Haiti: A Warning Sign

Introduction: Cardiovascular disease is the leading cause of death in Haiti and many low-middle income countries. Environmental lead exposure is associated with higher blood pressure (BP) and cardiovascular disease mortality in high income countries but has not been systematically evaluated in lower income countries where 6.5 billion people reside. Hypothesis: We hypothesized higher lead levels would be associated with higher BP in Haiti. Methods: Blood lead levels (BLLs) were measured among 2,257 participants ≥18 years enrolled in a population-based longitudinal cohort study in Port-au-Prince (Haiti Cardiovascular Disease Cohort Study). BLL screening was conducted using LeadCare II (detection limit ≥3.3 μg/dL). BLLs below detection were imputed. Associations between BLLs (quartiles) and systolic BP (SBP) and diastolic BP (DBP) were assessed, adjusting for age, sex, obesity, smoking, physical activity, and income. BLLs were also categorized as ≥5 versus <5 μg/dL. Results: The median age was 40 years; 62.6% were female. The geometric mean BLL was 4.60 μg/dL, 67.3% had detectable BLLs >3.3 μg/dL, and 40.9% had elevated BLLs ≥5 μg/dL. BLLs in quartile four (≥6.5 μg/dL) in both unadjusted and adjusted analyses were associated with higher SBP (adjusted 3.02 mmHg; 95%CI 0.80, 5.25) and DBP (adjusted 2.19 mmHg; 95%CI 0.70, 3.67). BLL ≥5 μg/dL were associated with a higher SBP (2.21 mmHg; 95%CI 0.15, 4.26) and DBP (1.50 mmHg; 95%CI 0.20, 2.81) in unadjusted analysis. After adjustment there was no difference in SBP (1.41; 95%CI -0.25, 3.09) and 1.15 mmHg (95%CI 0.01, 2.30) higher DBP. Conclusions: Widespread environmental lead exposure is evident in urban Haiti, with higher BLLs associated with higher SBP and DBP. Lead is a modifiable pollutant in low-income countries that warrants urgent public health remediation.

Child Lead Screening Behaviors and Health Outcomes Following the Flint Water Crisis.

There is little research on lead (Pb) screening behaviors and outcomes and possible health sequelae of children in Flint, Michigan in the years following the city's 2014 water crisis, which included widespread tap water contamination with elevated levels of heavy metals and other environmental contaminants. Between June and November 2019, we collected and analyzed cross-sectional data on Flint children's demographics and self-report of screenings of blood lead levels (BLLs) and results and various potential water contamination-related health symptoms andoutcomes. We calculated descriptive statistics to summarize the prevalence of health outcomes and screenings in children, and fit multivariable models using generalized estimating equations to characterize the association between baseline traits and health symptoms and outcomes in children. A total of 244 children (mean age 8.6 ± 4.8) were included in the analysis. Overall, 76.6% of the children were reported to have been screened for elevated BLLs after the water source switch. In total, after the water source switch, 25.0% of children were reported as having clinician-diagnosed elevated BLLs. Overall, 43.9% of children experienced hyperactivity, 39.3% had emotional agitation, 29.1% had comprehension issues/learning delays, while 38.9% of children had skin rashes and 10.7% experienced hair loss. A child having elevated BLLs also significantlyincreased the odds of experiencing adverse cognitive/behavioral outcomes (comprehension issues/learning delays OR = 4.0, hyperactivity OR = 6.6, emotional agitation OR = 3.5). Child BLL screening following the crisis initiation was moderate, and BLLs and potential water contamination-related morbidity outcomes appeared heightened. Further research is needed to contextualize epidemiologic factors contributing to BLL screening patterns and results and the potential water contamination-associated sequelae observed here.

Making the grade with quality reports

The current volume of The Journal includes a study from Fogel et al at Penn State, which reports on the results of a quality improvement study at their institution. These workers aimed to improve adherence with current guidelines on lead screening in children in some of their affiliated practices. The study found that an educational intervention produced very little change in practitioner behavior, as assessed by medical record documentation of appropriate lead testing. However, introduction of a point of care (POC) testing device in one of the clinics resulted in striking and durable improvement in screening. Quality improvement initiatives are ubiquitous in children's hospitals these days, and clearly provide value added to the children and families served. However, we rarely publish single-center studies such as this one. We believe that QI initiatives are generally specific to the institutions conducting them, and rarely have the type of generalized impact that we like to see in manuscripts we publish. That being said, there were 3 reasons we believed that this study was appropriate for The Journal. First, of course, the problem was important. Beyond that, the study was very nicely designed, undertaken, and reported. As such, it can provide a model for such reports in the future. Finally, the report drives home a common observation in quality intervention science. "Education," while admirable, rarely produces lasting changes in behavior. Meaningful change in provider behavior in this study only occurred when a novel intervention (a technology) made it possible to change a process, making it easy for the test to be ordered and performed while the child was still in the clinic. Article page 206 ▸ Point-of-Care Testing Improves Lead Screening Rates at 1- and 2-Year Well VisitsThe Journal of PediatricsVol. 233PreviewTo increase blood lead level screening rates in children at 12- and 24-month well visits through provider education and the implementation of a point-of-care (POC) lead screening program in 4 primary care practice offices located in and neighbored by counties with ≥5% prevalence of blood lead levels ≥5 μg/dL. Full-Text PDF

Point-of-Care Testing Improves Lead Screening Rates at 1- and 2-Year Well Visits

To increase blood lead level screening rates in children at 12- and 24-month well visits through provider education and the implementation of a point-of-care (POC) lead screening program in 4 primary care practice offices located in and neighbored by counties with ≥5% prevalence of blood lead levels ≥5μg/dL. Baseline data were collected July 2017 to June 2018. All providers received education on screening recommendations and local prevalence of elevated blood lead levels in July 2018. POC testing began June 2019 at 1 of the 4 practice sites. Screening rates were measured by electronic medical record abstraction. Rates were plotted monthly on statistical process control charts during implementation and analyzed using logistic regression under an interrupted time series approach for program evaluation. There was a small but significant increase in screening following provider education (OR 1.04 per month, 95% CI 1.02-1.07). POC testing was associated with a substantial immediate increase (OR 4.17, 95% CI 2.45-7.09) and a substantial continued increase (OR 1.34 per month, 95% CI 1.17-1.54) in screening at the site that implemented POC. POC testing substantially increases blood lead level screening rates at 12- and 24-month well visits and may be beneficial in other primary care settings.

A Retrospective Analysis of Blood Lead Levels in Newly Arrived Immigrant Children, Miami-Dade County, Florida, 2013-2016.

The Centers for Disease Control and Prevention's (CDC's) recommendation for blood lead level (BLL) screening of refugee children is to test new arrivals aged 6 months to 16 years. No such recommendations exist for testing immigrant children. Our objective was to provide evidence in support of creating lower age-specific guidelines for BLL screening for newly arrived immigrant populations to reduce the burden of unnecessary BLL testing. We conducted a 3-year (2013-2016) retrospective analysis of BLLs of 1349 newly arrived immigrant children, adolescents, and young adults aged 3-19 who visited the University of Miami Pediatric Mobile Clinic in Miami, Florida. We obtained capillary samples and confirmed values >5 μg/dL via venous sample. The primary outcome was BLL in μg/dL. The main predictor variable was age. We further adjusted regression models by poverty level, sex, and ethnicity. Of 15 patients with a BLL that warranted further workup and a lead level of concern, 9 were aged 3-5 and 6 were aged 6-11. None of the adolescent and young adult patients aged 12-19 had a lead level of concern. Nearly half of the patients (n = 658, 48.8%) lived in zip codes of middle to high levels of poverty. This study provides evidence to support the creation of lower age-specific guidelines for BLL screening among newly arrived immigrant children and adolescents. Future studies should elucidate appropriate age ranges for BLL testing based on epidemiologic evidence, such as age and country of origin.

A Denver Refugee Clinic Blood Lead Level Analysis in Refugee Females of Reproductive Age, 13-45years, 2014-2019.

The objective was to determine if refugee females of reproductive age (FRA) are at risk of having elevated blood lead levels (BLL). A retrospective quality improvement project conducted at a Denver community health center (9/2014-3/2019) evaluated BLLs from initial domestic medical examinations (DME) in 312 FRA refugees (13-45years). Associations between elevated BLL and demographic factors were explored using multivariable regression analysis. Of 312 FRA refugees, BLLs ranged from < 2.0 to 26.2 mcg/dL, 5% had elevated BLLs. Of pregnant refugees (49), 4% had elevated BLLs. Afghani country of origin was positively associated with elevated BLLs, adjusting for age (FRA: Prevalence Ratio 6.90 [2.68-17.77], p < 0.0001). Afghani FRA refugees, irrespective of pregnancy and breast-feeding status, should have BLL testing at DME. Nationally representative evaluations of FRA refugees are needed to determine if BLL screening should be expanded to all FRA refugees, irrespective of pregnancy or breast-feeding status.

Accuracy of lead risk assessment questionnaire in predicting elevated blood lead levels in children

Background: Lead toxicity in children is a serious problem affecting their neurodevelopment. Although CDC mandates screening for lead toxicity regularly in children, India doesn’t have any lead related public health program in place. In resource limited India a prescreening lead risk assessment questionnaire will be more economical than universal screening for blood lead levels (BLL). Authors aim to evaluate the accuracy of a validated modified CDC lead risk assessment questionnaire in predicting elevated BLL.Methods: Authors conducted an explorative cross-sectional study from July to August 2017 in 340 children aged 6 months to 6 years. A standardized self-administered questionnaire modified from CDC lead risk assessment questionnaire was administered in the children. Also, BLL were measured in all study subjects using lead care II analyser. Data from questionnaire were compared with BLL to test the accuracy of questionnaire.Results: Blood lead levels was high (&gt;5ug/dl) in 57.9% of study subjects especially in children between 24-35 months. Employment in battery manufacturing companies (P=0.0001), usage of cosmetics (P=0.019), parental smoking history (P=0.001), involvement in painting, arts (P=0.0001) and malnourished children (P=0.018) were the risk factors associated with undesirable BLL. The modified questionnaire had a sensitivity of 87.9% and specificity of 66.7% for detecting elevated BLL.Conclusions: The modified CDC lead risk assessment questionnaire is a sensitive tool in identifying high risk cases of lead toxicity in children.

The Prevalence of Elevated Blood Lead Levels in Foreign-Born Refugee Children Upon Arrival to the U.S. and the Adequacy of Follow-up Treatment.

This study sought to evaluate the prevalence of blood lead levels (BLL) in refugee children upon arrival to the U.S. and determine whether they received BLL screening and follow-up according to CDC guidelines. 301 refugee children ages 6months to 16years were seen at the International Family Medicine Clinic from 2003 to 2016. Data were collected on BLL, treatment, age, gender, English proficiency, native language, anemia, malnutrition, and microcytosis. Bivariate analyses were conducted to determine the association between these variables and BLL. The prevalence of elevated blood lead levels (EBLL), defined as ≥ 10µg/dL before June 2012 and ≥ 5µg/dL from June 2012, was observed in 13% (n = 39). Male sex (p = 0.033), young age (p = 0.003), and microcytosis (p = 0.009) were significantly associated with EBLL. Follow-up and treatment for EBLL were lower than the recommended CDC guidelines for BLL and greater education of healthcare providers is needed.

Should Children With Constipation Undergo Blood Lead Level Screening?

This study aimed to compare the prevalence of elevated blood lead level in children with constipation to the population prevalence. We reviewed the charts of 441 children who were screened with a blood lead level on presenting to the gastroenterology clinic at UPMC Children's Hospital of Pittsburgh for evaluation of constipation. The prevalence of blood lead level greater than 5 µg/dL was 1.36% (6/441; 95% confidence interval = 1.23% to 1.49%), which is significantly lower than the 4.01% prevalence in the population reported by the Center for Disease Control and Prevention. No patients had a blood lead level greater than 10 µg/dL. Age under 5 years old showed an increased odds of lead level greater than 5 µg/dL (odds ratio = 7.5; 95% confidence interval = 1.2 to 47.3, P < .05). We concluded that children seen in the gastroenterology clinic for constipation are unlikely to have an elevated blood lead level on routine screening.

Resurgent lead poisoning and renewed public attention towards environmental social justice issues: A review of current efforts and call to revitalize primary and secondary lead poisoning prevention for pregnant women, lactating mothers, and children within the U.S.

The recent Colorado Gold King Mine waste-water spill and Michigan's water supply re-routing program catastrophe, has directed renewed public attention towards resurgent environmental lead contamination threats. Leaded environments present social justice issues for children and mothers possessing blood lead levels (BLLs) > 5 μg/dL. Childhood lead exposure remains a continual U.S. public health problem manifesting in lifelong adverse neuropsychological consequences. The 2007 Inspector General Report demonstrated low BLL screening rates across the U.S. and this study examined the regularity of children's BLL screening rates. The Centers for Disease Control and Prevention (CDC) Lead Poisoning National Surveillance2010-2014 children's BLL screening rates, were examined to assess BLL screening regularity in states traditionally known to have regularly occurring BLL screenings: New York, New Jersey, and Pennsylvania. The results extracted from the CDC data showed that < 50% of children were BLL screened by six-years of age across the states that were sampled. The findings highlight that without a "clear map" of lead exposed areas through accurate and consistent BLL screenings, how the potential for such disparities within - and between-states within the U.S. could arise due to environmental social justice issues in relation to BLL screening barriers. Barriers preventing children's BLL screenings were considered, and public health interventions recommended to improve screening rates included: routine BLL screening for all pregnant women, lactating mothers, and children; while, removing known lead exposure sources within communities. This study calls for action during a time of renewed public attention to resurgent lead poisoning within the U.S.

Determining Childhood Blood Lead Level Screening Compliance Among Physicians.

Childhood Lead Poisoning Prevention Programs throughout the U.S. have addressed childhood lead poisoning by implementing primary and secondary prevention efforts. While many programs have helped increase screening rates, in some states children under the age of six still have not been tested for lead. This study aims to identify the barriers to childhood blood lead testing and develop a strategy to increase the number of children tested. Clark County physicians who work with children six and under were surveyed about blood lead level (BLL) testing practices, particularly, adherence to Centers for Disease Control and Prevention (CDC) guidelines, and parental compliance with orders to have their children tested to determine their blood lead levels. In addition, select in-person interviews were conducted with physicians who reported high parental compliance to identify best practices and barriers. Of the 77 physicians that provided data, 48% indicated they did not follow CDC guideline compared to 52% who follow guidelines. 18 of the 30 (or 60%) physicians reported more than 80% of parents complied with doctor recommended BLL testing. Twelve physicians identified cost, lack of insurance, and absence of symptomology as persistent barriers to lead screening. This study identified barriers to childhood lead screening including inadequate parental adherence to physician-ordered screenings and physician non-compliance with screening recommendations are two primary contributors. Addressing these issues could increase screening in children and reduce the risk of lead poisoning.

Lead Levels in Landfill Areas and Childhood Exposure: An Integrative Review.

Landfills are high-risk areas for environmental lead exposure for children living in poverty stricken areas in many countries. This review examines landfills and lead toxicity in children. The review discusses the effects of lead toxicity, provides evidenced based recommendations to reduce lead exposure, and identify gaps in the evidence. A database search was conducted of articles in English from 1985 to 2014. Ten articles met the inclusion criteria. The Whittemore and Knafl framework and the John Hopkins Research Evidence Appraisal Tool© were used for reviewing the data. Elevated blood lead levels (BLLs) of children living near landfills were related to increased soil lead levels. Toxic effects of lead included adverse outcomes such as encephalopathy or death for children. Different approaches to decrease lead level include environmental surveillance, BLL screening, and soil abatement which are costly. Increased BLL through environmental exposure is connected with poor health outcomes and death among children. Evidence-based prevention included monitoring and screening and costly soil abatement. It is recommended that future studies focus on community education for exposure avoidance for children living near landfill areas.

Evaluation of the Blood Lead Screening Component of the Southern Nevada Childhood Lead Poisoning Prevention Program.

While public health programs and policies have worked to reduce lead exposure, lead poisoning remains a major preventable public health concern in the United States. In Clark County, Nevada, blood lead level (BLL) screening has historically been sparse. Thus, the purpose of this study was to evaluate the impact of the Southern Nevada Childhood Lead Poisoning & Prevention Program (CLPPP) in increasing screening efforts and identifying children with elevated blood lead levels (EBLLs). The proportion of children screened after the implementation of the CLPPP and the number of children identified with detectable BLLs. A total of 43 028 BLL results for children younger than 6 years were assessed from 2006 to 2011. More than 19% of children tested during the project period had a detectable BLL. The number of BLL tests for children younger than 6 years increased from 4180 in 2005-2006 to 9304 in just the second year of CLPPP implementation. Once the initial implementation grant was over and additional funding was unavailable, the BLL screening once again declined to 5541 in 2016-2017. Evaluation of CLPPP activities suggests that outreach and education efforts, funded by the Centers for Disease Control and Prevention, played a significant role in increasing blood lead screening in Southern Nevada. However, despite these efforts, less than 5% of all children younger than 6 years were screened, which has declined further after the end of federal support.

The Utility and Financial Implications of Obtaining Routine Lead Levels for Child Psychiatric Inpatients

This study attempted to challenge the CDC recommendations regarding routine screening blood lead levels in children. The purpose was to determine the efficacy of obtaining routine lead levels on all patients admitted to a child psychiatric inpatient unit. A retrospective chart review of children admitted to a psychiatric inpatient unit during a 12 month period. The audit determined average lead levels and costs associated with the screening program. 1 of 61 admitted children was found to have an elevated lead level. Number needed to treat was determined to be 98. The cost per case detected was determined to be over $8,600. Routine screening for blood lead levels in all children admitted to a psychiatric inpatient unit does not appear efficacious or cost effective.

Blood lead levels in the United States “Oldest-Old” population

Context. Previous studies have suggested significant endogenous lead release from bony stores in the elderly raising the concern for elevated blood lead levels in that population. Objective. We undertook to determine the range of blood lead levels in the “oldest-old” population, a demographic category that includes persons aged 80 years and older. Materials and methods. We analyzed blood lead level data from the National Health and Nutrition Examination Survey (NHANES) for the years 1999–2010 for persons aged 80 years and older. We also screened an inner-city population of patients aged 80 years of age and older presenting to an emergency department. Results. Among persons aged 80 years and older sampled in the NHANES surveys, the geometric mean blood lead level each year varied from 1.98 to 2.66 mcg/dL. Of the 2,168 measured blood lead levels, only 15 samples (0.69%) exceeded our a priori definition of an elevated blood lead level (greater than 10 mcg/dL). Of those 15 samples, the highest blood lead level was 15.3 mcg/dL. For our screening of an inner-city oldest-old population, we enrolled 76 subjects and found a geometric mean blood lead level of 1.72 mcg/dL. Discussion. Several considerations place elderly persons at a theoretically increased risk of elevated blood lead level, including previously documented birth cohort effect for blood lead levels with older cohorts having higher mean blood lead levels and concern for endogenous lead exposure due to release of lead from bony stores. However, our statistical analysis of NHANES data and screening of an inner-city oldest-old population suggests that elevated blood lead levels in this population are rare. Conclusion. Routine blood lead level screening in the elderly is not indicated.