BLOOD LEAD SCREENING PRACTICES AMONG US PEDIATRICIANS

Objectives. In 1991, the Centers for Disease Control and Prevention (C DC) decreased the blood lead level of concern to 10 mu g/dL (0.48 mu m ol/L) and recommended universal screening. Because these guidelines co ntinue to provoke controversy, we conducted a study to: 1) estimate th e proportion of pediatricians who are members of the American Academy of Pediatrics (AAP) who report screening for elevated blood lead level s; 2) describe their clinical practices regarding screening for elevat ed blood lead levels; 3) compare attitudes of universal screeners, sel ective screeners, and nonscreeners; and 4) identify characteristics of pediatricians who universally screen. Design. Confidential, cross-sec tional survey of a nationally representative random sample of 1610 ped iatricians conducted through the AAP Periodic Survey. Subjects. The st udy included 1035 responders (64% response rate). Analysis was limited to the 734 pediatricians who provide well-child care tie, primary-car e pediatricians). Results. Fifty-three percent of pediatricians report ed screening all their patients aged 9 to 36 months, 39% reported scre ening some, and 8% reported screening none. Among those who screen, 96 % use a blood lead assay. The primary risk factors for which selective screeners screen are: history of pica (94%); living in an older home with recent renovations (92%); living in an older home with peeling pa int (93%); and having a sibling who had an elevated blood lead level ( 88%). Among primary-care pediatricians, 73% agree that blood lead leve ls greater than or equal to 10 mu g/dL should be considered elevated, and 16% disagree. However, 89% of primary-care pediatricians believe t hat epidemiologic studies should be performed to determine which commu nities have high proportions of children with elevated blood lead leve ls, and 34% of primary-care pediatricians believe that the costs of sc reening exceed the benefits. Conclusions. Three years after the Center s for Disease Control and Prevention issued new guidelines for the man agement of elevated blood lead levels, a slight majority of primary-ca re pediatricians in the United States who are members of the AAP repor t that they universally screen their appropriately aged patients, whil e most of the remaining pediatricians report screening high-risk patie nts. Many pediatricians may want additional guidance about circumstanc es under which selective screening should be considered.