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Elevated Lead, Due for retesting
Because recent epidemiologic
data have shown that lead exposure is still common in certain communities in
the US Preventative Service Task Force: Screening
for elevated lead levels by measuring blood lead at least once at age 12
months is recommended for: ·
All children at increased risk of lead
exposure. ·
All children with identifiable risk
factors. ·
All children living in communities in
which the prevalence of blood lead levels requiring individual intervention,
including residential ·
Lead hazard control or chelation therapy,
is high or is undefined. Evidence
is currently insufficient to recommend an exact community prevalence below
which targeted screening can be substituted for universal screening.
Clinicians can seek guidance from their local or State health department. There is insufficient evidence to recommend for or against: ·
Routine screening for lead exposure in
asymptomatic pregnant women, but recommendations against such screening may
be made on other grounds. ·
Counseling families about the primary
prevention of lead exposure, but recommendations may be made on other
grounds. Advisory Committee on Childhood Lead Poisoning Prevention
(ACCLPP) ACCLPP Recommendations for Health-Care Providers: ·
All children enrolled in Medicaid should
be screened with a blood lead test at ages 12 and 24 months or at ages 36--72
months if they have not previously been screened. ACCLPP recommends administration of a blood lead screening test
for all children enrolled in Medicaid at ages 12 and 24 months; children who
have not previously been screened should be tested at ages 36--72 months
(11). Administrating a risk-assessment questionnaire instead of a blood lead
test does not meet Medicaid requirements. If children are exposed to lead, their BLLs tend to increase
during ages 0--2 years and peak at ages 18--24 months (12). Therefore,
screening is recommended at both ages 1 and 2 years to identify children who
need medical management and environmental and public health case management
(2). Identifying a child with an elevated BLL at age 1 year might prevent
additional increases during ages 1--2 years. In
addition, a child with a BLL <10 µg/dL at age 1 year might have an
elevated level by age 2 years, underscoring the importance of rescreening at
age 2 years. For example, among children at selected clinics in high-risk
areas of Chicago in 1997, the prevalence of elevated BLLs (>10 µg/dL) was
17% among children approximately aged 1 year and 29% among children
approximately aged 2 years (Helen Binns, M.D., M.P.H., Children's Memorial
Hospital, Northwestern University Medical School, personal communication,
January 2000). Thirty-nine percent of children whose BLLs were <10 µg/dL
at age 1 year (during 1995--1996) were retested at age >2 years (during
1996--1997), and 21% had developed elevated BLLs since their initial
screening. Screening is recommended
for previously untested children aged <6 years to rule out subclinically
elevated BLLs during critical stages of development. Within
the state or locale for which this recommendation is made, child health-care
providers should use a blood lead test to screen. Children at ages 1 and 2,
and children 36-72 months of age who have not previously been screened, if
they meet one of the following criteria: •
Child resides in one of these zip codes: [place here a list of all zip codes
in the state or jurisdiction that have 27% of housing built before 1950. This
information is available from the U.S. Census Bureau.] •
Child receives services from public assistance programs for the poor, such as
Medicaid or the Supplemental Food Program for Women, Infants, and Children
(WIC). •
Child’s parent or guardian answers yes or don’t know to any question in a
basic personal-risk questionnaire consisting of these three questions: o
Does your child live in or regularly
visit a house that was built before 1950? [This question could apply to a
facility such as a home, day-care center, or the home of a babysitter or
relative.] o
Does your child live in or regularly
visit a house built before 1978 with recent or ongoing renovations or
remodeling (within the last 6 months)? o
Does your child have a sibling or
playmate who has or did have lead poisoning? In the absence of a statewide plan or other formal guidance from
health officials, universal screening for virtually all young children, as
called for in the 1991 edition of Preventing Lead Poisoning in Young Children
(CDC, 1991), should be carried out. Massachusetts
Department of Public Health Childhood Lead Poisoning Prevention Program
(CLPPP): The
This reminder
prompts clinicians to retest individuals who have the following recorded indicators within
the electronic health record (EHR) system: ·
Age < 5 years; and ·
most recent lead test (capillary or
venous) ≥10 References 1. 2. 3. 4. Advisory
Committee on Childhood Lead Poisoning Prevention (ACCLPP), Recommendations
for Blood Lead Screening of Young Children Enrolled in Medicaid: Targeting a
Group at High Risk. MMWR; Dec 08,
2000/49(RR14); 1-13. 5. Centers
for Disease Control and Prevention (CDC) Web Links 1. American
Academy of Pediatrics (AAP) 2. Massachusetts
Department of Public Health Childhood Lead Poisoning Prevention Program
(CLPPP) http://www.mass.gov/dph/clppp/ 3. US
Preventative Service Task Force http://www.ahrq.gov/clinic/uspstf/uspslead.htm 4. Advisory
Committee on Childhood Lead Poisoning Prevention (ACCLPP) http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4914a1.htm 5. Centers
for Disease Control and Prevention (CDC) http://www.cdc.gov/nceh/lead/guide/guide97.htm
Implementation
Notes
These rules
and/or reminders were created using national, state and local guidelines, and
group consensus regarding best practices. These guidelines, and their
interpretation by clinicians at Partners Healthcare System, may not represent
the standard of care across all regions or settings, and are not intended to
be adopted or applied without independent assessment of their suitability for
a particular setting. Moreover, guidelines change over time (for example, the
age range for children who should receive influenza vaccinations was recently
extended to 59 months). The rules and/or reminders may need the addition or
modification of certain items to ensure that they remain consistent with
current guidelines. Therefore, the rules and/or reminders included here are
intended only as examples or guides for the development of similar rules
and/or reminders in other settings. Partners Healthcare System and its
affiliates disclaim any and all responsibility or liability associated with
the use of the rules and/or reminders displayed here by third parties. |