Children with high blood lead levels often do not receive follow-up tests

Only about half of children who had an abnormal blood lead level screening had follow-up blood testing, according to an article in the May 11 issue of JAMA.

"In 1997, the Centers for Disease Control and Prevention (CDC) changed the recommendation for childhood lead poisoning prevention from near-universal testing of all children to targeted testing based on the risk of lead exposure," according to background information in the article. The recommendation was changed because of a decreased prevalence of lead poisoning due to the success of prevention strategies, such as the removal of lead from paint and gasoline. Efforts have been made to improve screening among at-risk children because even modest elevations of blood lead levels can be harmful. However, screenings are only effective with follow-up care.

Alex R. Kemper, M.D., M.P.H., M.S., from the University of Michigan, Ann Arbor, and colleagues determined the proportion of 3,682 Medicaid-enrolled children with elevated lead levels who had follow-up testing done. The study included children ages six years or younger who had a screening blood lead level of at least 10 ìg/dL (micrograms per deciliter) between January 1, 2002 and June 30, 2003. The researchers determined that follow-up testing had taken place if it was performed within 180 days of the initial blood lead screening.

The researchers found that 53.9 percent of the children received follow-up testing within 180 days of their elevated blood level tests. These children were given follow-up at an average of 68.5 days. The average blood lead level at follow-up was 3.6 ìg/dL lower than the initial testing, although 47.5 percent of children still had elevated blood levels. Follow-up testing was less likely for Hispanic or nonwhite children than for white children; for children living in urban settings compared to rural areas; and for children living in high- compared with low-risk lead areas. Among children who did not receive follow-up testing, 58.6 percent had at least one medical visit during the 180 days following the abnormal level screening.

"… follow-up testing is the cornerstone of lead poisoning management and an essential component of secondary prevention," the authors write. "To maximize cognitive development in these children, it is crucial to improve follow-up and to understand and develop interventions to overcome these unexpected disparities in care."