Difficulties in Evaluating Abnormal Lead Screening Results in Children

Abstract

Background: This report chronicles efforts to provide follow-up care for children with abnormal whole blood lead concentrations using the 1991 Centers for Disease Control and Prevention (CDC) guidelines in the Family Health Center at Shadyside Hospital in Pittsburgh.

Methods: An automated surveillance module found all children with abnormal lead concentrations obtained between January 1994 and July 1995 and singled out children who were' overdue for follow-up. Automated physician reminders and nursing case management were used to improve care and documentation. Longitudinal case summaries were used to evaluate care.

Results: All 99 children with a lead concentration of 10 μg/dL or greater had a documented follow-up plan. Twenty-nine children (47 percent) who had a lead concentration of 10 to 14 μg/dL, 23 (100 percent) who had a lead concentration of 15 to 19 μg/dL, and 8 (100 percent) who had a lead concentration of 20 μg/dL or greater had at least one follow-up lead concentration measurement by the end of the data collection in July 1995. Follow-up was incomplete in more than 70 percent of children. Nineteen children (19 percent) with initially abnormal lead concentrations had follow-up testing with persistently normal results. The yearly cost of follow-up was $15,888, with only 7 children requiring county health environmental intervention.

Conclusions: The nurse-centered, computer-aided system improved follow-up care of children with abnormal lead concentrations, but most patients still did not receive mandated follow-up testing because of logistic obstacles. The effort and cost associated with CDC-mandated follow-up of children with lead concentrations between 10 and 19 μg/dL provides no apparent benefit and might detract from the care of children at higher risk.