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Effectiveness of a Pediatric Verbal Lead Exposure Screening Protocol in Emergency Department Patients

Creighton, Sara MD*†; Hafner, John W. MD, MPH‡§; Aldag, Jean C. PhD

doi: 10.1097/PEC.0b013e3182808abe
Original Articles

Purpose The population demographics found in many urban emergency departments (EDs) often mirrors those of children at risk for elevated serum lead levels. We evaluated the effectiveness of a verbal lead screening program for screening high-risk children presenting to the ED.

Methods A prospective observational cohort study was conducted of children aged 9 months to 6 years, living in 2 target counties and presenting to an urban, academic, Midwestern ED. Those with a prior lead level, enrolled in a program requiring lead testing, or with an unstable medical condition were excluded. A 6-question validated verbal survey was administered to all parents of eligible children, and the results recorded in the patient’s electronic medical record. Children who screened positive were referred to their local health department for blood lead testing. Health department records were reviewed for follow-up visits and blood lead levels.

Results During the study period, 3513 children were eligible (mean age, 2.6 years; 53.3% male), with 815 patients screened and 209 (25.6%) screening positive. Most positively screened patients (71.8%) documented only 1 affirmative question, most often indicating they lived in a home built before 1978. Of those children who screened positive, 14.8% (31/209) had a blood lead level performed within 6 months. Of those tested, 4 children had an elevated lead level (>10 µg/dL).

Conclusions Use of an ED verbal lead exposure screening tool identified children requiring additional follow-up testing. However, health department–referred children had poor follow-up, and few children were ultimately documented with elevated lead levels.

From the *University of Illinois College of Medicine at Peoria; †Department of Pediatrics, OSF Saint Francis Medical Center/Children’s Hospital of Illinois; ‡Division of Emergency Medicine, University of Illinois College of Medicine at Peoria; §Department of Emergency Medicine, OSF Saint Francis Medical Center/Children’s Hospital of Illinois; and ∥Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL.

Disclosure: The authors declare no conflict of interest.

Reprints: John W. Hafner, MD, MPH, 530 NE Glen Oak Ave, Peoria, IL 61637 (e-mail:

Presented at the American College of Emergency Physicians Scientific Assembly Research Forum (poster presentation), Las Vegas, NV, September 2010, and at the American Academy of Pediatrics National Conference and Exhibition (poster presentation), San Francisco, CA, October 2010.

© 2013 Lippincott Williams & Wilkins, Inc.