Validation and Assessment of Pediatric Lead Screener Questions for Primary Prevention of Lead Exposure

Abstract

Objective. Pediatric lead screener questions have previously been evaluated for their ability to identify children whose blood lead levels (BLLs) are greater than 10 µg/dL. Based on recent policy changes stressing that there is no safe BLL for children, the current study reevaluates the screener questions for their ability to identify children with BLLs less than 2 µg/dL and the validity of the questions in positively identifying those at greater risk for exposure. Method. A total of 202 parents of children enrolled in Head Start programs were administered the pediatric lead screener, questions to validate the screener questions, and children’s BLLs were collected in Summer 2013. Pediatric screener questions were validated against children’s BLL and the more comprehensive questions on lead risk. Results. In predicting BLL greater than 2 µg/dL, the pediatrician screener tool had a sensitivity of 26.3% and specificity of 72.2%. Each of the screener questions had low sensitivities for identifying children with BLLs above 2 µg/dL. The screener questions did not demonstrate adequate validity when compared against a more comprehensive battery of lead exposure risk indicators. The validation questions improved sensitivity to detect children with BLL >2 µg/dL and reduced the number of false positives. Conclusion. The pediatrician screener questions in their current format are not a useful primary prevention tool in identifying children at greater risk for lead exposure and in need of secondary prevention through the receipt of a blood lead test. A revision to the protocol for identifying children at risk could result in better primary and secondary prevention efforts.