Lead Screening Practices of Pediatricians and Family Practice Physicians in the Rappahannock Area Health District

JEANETTE CURRENCE

Purpose. This study looks at the screening practices of pediatricians and family practice physicians in the Rappahannock Area Health District (RAHD), consisting of the counties of Stafford, Spotsylvannia, King George, and Caroline and the city of Fredericksburg, to identify the impact on the actual reportable incidence levels of elevated lead in children ages one through five. This study addresses the question “Is lead toxicity a disappearing problem” because of lack of identification of children with elevated lead levels?

Methods. A confidential, cross-sectional survey of pediatricians and family practice physicians in the RAHD regarding screening and testing practices was sent to 49 physicians, with 21 (43%) responding. Case studies of seven out of the eleven children, ages one through five in the RAHD, identified by the VDH to have elevated lead levels was conducted using the individual medical record and a uniform confidential interview of the child’s parent or guardian.

Results. Sixty percent of the physicians reported screening most (76 to 99% of the time) of their patients aged 9 to 36 months for elevated lead levels, 20% reported screening some (26 to 75% of the time), and 20% reported screening seldom (< 25% of the time). Only twenty percent of physicians reported having to actually perform a blood test on a child aged 9 to 36 months for elevated lead levels most of the time, 20% reported testing some of the time, and 60% reported seldom ever testing. Ninety four percent of all responding physicians have tested children aged nine months to five years of age for the following three risk factors: a sibling with a history of elevated blood lead levels (BLL); child lives in home built before 1978; and a child with a history of PICA (eating non-food items). Overall, physicians who reported screening children most of the time were more likely to believe that the benefits of screening outweigh the costs of screening than were those who reported screening children selectively.