LEAD-POISONING RISK DETERMINATION IN AN URBAN-POPULATION THROUGH THE USE OF A STANDARDIZED QUESTIONNAIRE

Background. The Centers for Disease Control and Prevention (CDC) has r ecommended using a five-item questionnaire at every regular office vis it for all children 6 to 72 months of age to identify those at risk of high-dose exposure to lead. Objective. To determine how well the ques tionnaire identifies children with elevated lead levels. Research desi gn. Comparison of results of the questionnaire, which is intended to i dentify children as being low-risk or high-risk for lead poisoning, wi th children's blood lead levels. Setting. A pediatric continuity clini c located in a major teaching hospital in Rochester, NY. Patients. A c onsecutive sample of 476 children aged 6 to 72 months without a prior history of lead poisoning who were seen in the clinic in July and Augu st 1992, and who had not had a lead screen in the previous 6 months (f or those aged < 36 months) or 12 months (for those aged 36 to 72 month s). Measurements and main results. Fingerstick lead samples were obtai ned from all children, and those greater than or equal to 15 mu g/dL ( 0.72 mu mol/L) were confirmed by subsequent venous lead determinations . Twenty-eight percent had blood lead levels greater than or equal to 10 mu g/dL (0.48 mu mol/L), 8% had levels greater than or equal to 15 mu g/dL (0.72 mu mol/L), and 5% had lead levels greater than or equal to 20 mu g/dL (0.96 mu mol/L). According to responses on the questionn aire, 44% were initially classified as low-risk, and 43% were high-ris k. In 13% risk could not be determined because one or more items on th e questionnaire had not been answered or were answered equivocally, wh ereas all other items were answered ''No.'' Children for whom risk cou ld not be determined were presumed to be at high risk and were added t o that category, resulting in 56% of the study population so designate d. The questionnaire was moderately effective in identifying children with elevated lead levels. Seventy percent of children having lead lev els greater than or equal to 10 mu g/dL (0.48 mu mol/L) and 82% of chi ldren having lead levels greater than or equal to 15 mu g/dL (0.72 mu mol/L) had been classified as high-risk by the questionnaire. Children classified as low-risk were very unlikely to have elevated lead level s. Eighty-one percent of low-risk children had lead levels < 10 ug/dL and 97% had lead levels < 15 ul/dL. An abbreviated questionnaire using only the first three items from the CDC questionnaire had almost iden tical effectiveness. Conclusions. In this clinical setting, in which c hildren are largely urban, poor, and have a moderate to high risk of d eveloping elevated lead levels, the CDC risk assessment questionnaire is effective in identifying children with elevated lead burdens. Howev er, an abbreviated version of the questionnaire may be as effective as the complete questionnaire. Additional questions should be added to t he questionnaire to improve its overall sensitivity, and the questionn aire should be tested in other settings to see if it is effective with children having different environmental exposures to lead.