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PubMed1997

Value of posterior and right ventricular leads in comparison to the standard 12-lead electrocardiogram in evaluation of ST-segment elevation in suspected acute myocardial infarction.

In this multicenter prospective trial, we studied posterior (V7 to V9) and right ventricular (V4R to V6R) leads to assess their accuracy compared with standard 12-lead electrocardiograms (ECGs) for the diagnosis of acute myocardial infarction (AMI). Patients aged >34 years with suspected AMI received posterior and right ventricular leads immediately after the initial 12-lead ECG. ST elevation of 0.1 mV in 2 leads was blindly determined and inter-rater reliability estimated. AMI was diagnosed by World Health Organization criteria. The diagnostic value of nonstandard leads was determined when 12-lead ST elevation was absent and present and multivariate stepwise regression analysis was also performed. Of 533 study patients, 64.7% (345 of 533) had AMI and 24.8% received thrombolytic therapy. Posterior and right ventricular leads increased sensitivity for AMI by 8.4% (p = 0.03) but decreased specificity by 7.0% (p = 0.06). The likelihood ratios of a positive test for 12, 12 + posterior, and 12 + right ventricular ECGs were 6.4, 5.6, and 4.5, respectively. Increased AMI rates (positive predictive values) were found when ST elevation was present on 6 nonstandard leads (69.1%), on 12 leads only (88.4%), and on both 6 and 12 leads (96.8%; p <0.001). Treatment rates with thrombolytic therapy increased in parallel with this electrocardiographic gradient. Logistic regression analysis showed that 4 leads were independently predictive of AMI (p <0.001): leads I, II, V3, V5R; V9 approached statistical significance (p = 0.055). The standard ECG is not optimal for detecting ST-segment elevation in AMI, but its accuracy is only modestly improved by the addition of posterior and right ventricular leads.

Aged↗
PubMed1989

Active fixation atrial leads: randomized comparison of two lead designs.

Active fixation leads have reduced the incidence of lead dislodgement in patients with permanent pacemakers. However, theoretic concern that the tissue trauma associated with a myocardial screw-helix may increase the chronic pacing threshold of active compared to passive fixation leads has remained. Whether active fixation leads with a stimulating electrode that is independent of the fixation mechanism are associated with a lower chronic pacing threshold than leads utilizing a screw-helix for both fixation and stimulation is unknown. The present prospective, randomized study compared the acute and chronic atrial pacing and sensing characteristics of two unipolar active fixation leads, one utilizing a screw-helix for both fixation and electrical stimulation, the other with an active porous tip electrode and an electrically inactive helix. Patients were randomized to receive either a Medtronic 6957J lead with an electrically active myocardial screw-helix or a Cordis 329-101P lead with an inactive helix and a porous tip electrode. The baseline characteristics of the groups were comparable. At implantation, the 329-101P lead had a lower mean voltage threshold than the 6957J lead (0.61 +/- 0.16 V vs 1.05 +/- 0.34 V, P = 0.0004). There were no significant differences in atrial electrogram amplitude, slew rate, or lead impedance between the groups. At 6 weeks follow-up, there were no differences in the mean threshold voltage (1.85 +/- 0.36 vs 1.93 +/- 0.69 V), impedance (528 +/- 81 vs 530 +/- 118 ohms), or atrial electrogram amplitude (2.63 +/- 0.50 vs 2.42 +/- 0.95 mV) between the two leads. At long-term follow-up (mean 16.2 +/- 2.8 months, range 13.1-20.0 months) there were no significant differences in voltage threshold (1.65 +/- 0.61 vs 1.97 +/- 0.64 V), impedance (565.5 +/- 81.6 vs 617.7 +/- 146.7 ohms), or atrial electrogram amplitude (2.79 +/- 0.75 vs 3.10 +/- 1.53 mV). Thus, these results suggest that active fixation leads in the atrium with an electrode that is independent of the fixation mechanism do not provide chronic stimulation thresholds or electrogram amplitudes that are superior to those obtained with leads utilizing a myocardial screw-helix as both the active electrode and the fixation device.

Adult↗
PubMed1999

High impedance low energy pacing leads: long-term results with a very small surface area steroid-eluting lead compared to three conventional electrodes.

We evaluated the handling performance at implant, and the long-term atrial and ventricular electrical performance of a new generation using a very small surface area (1.2 mm2) steroid-eluting electrode (Medtronic CapSure Z). We compared the performance of CapSure Z to that of traditional passive fixation leads, with and without steroid elution. The study was conducted during 2 years of follow-up. We studied 188 patients (105 males and 83 females; mean age 71 +/- 7 years). All of the patients were implanted with a dual chamber pacemaker and the same type of lead in both chambers. Forty-one patients received CapSure Z leads, 25 patients received Target Tip leads (8-mm2 surface area; no steroid elution), 63 patients received CapSure leads (8-mm2 surface area; steroid elution), and 59 patients received CapSure SP leads (5.8-mm2 surface area; steroid elution). The four groups were homogeneous in regards to sex, age, cardiac disease, and reason for implant. At follow-up, the CapSure Z lead showed sensing values comparable to the other leads, with lower pacing thresholds and higher pacing impedance in both chambers. We evaluated the mean current drained from the pacemaker by the different types of leads when using safe, low energy output settings. We found that by using CapSure Z leads, the mean current was significantly lower than that of the other types of leads (0.42 microA for CapSure Z ventricular lead vs 0.85 for CapSure SP, 1.42 for CapSure, and 1.54 for Target Tip). Thus, the use of the CapSure Z lead, combined with low energy output programming, will increase pacemaker longevity compared to the use of traditional leads and standard output programming.

Aged↗
PubMed2004

Long-term experience with subcutaneous ICD leads: a comparison among three different types of subcutaneous leads.

ICDs provide protection against sudden cardiac death in patients with life-threatening arrhythmias. Nevertheless, efficacy of defibrillation remains an important issue to guarantee the future safety of patients who receive an ICD. There is a significant number of patients who need an additional subcutaneous lead to obtain a defibrillation safety margin of at least 10 J between the maximum output of the ICD and the energy needed for ventricular defibrillation. However, few data exists about the long-term performance of different types of subcutaneous leads. Therefore, the aim of this study was to analyze the long-term experience with three different types of subcutaneous leads. The study included 132 patients (109 men, 23 women; mean age 59.8 years [SD +/- 10.7 years]). All of them received a subcutaneous lead in addition to a single chamber or dual chamber ICD between October 1990 and April 2002. Two patients received a second subcutaneous lead after the first lead had been removed so that a total of 134 subcutaneous leads were evaluated. Inclusion criteria for the implantation of an additional subcutaneous lead were (1) unsuccessful ventricular defibrillation at implant without a subcutaneous lead, (2) insufficient safety margin (< 10 J) between the maximum output of the ICD and the energy needed for ventricular defibrillation, or (3) clinical evaluation of a new subcutaneous lead (Medtronic 13014). There were no significant differences between the three study groups with regard to age, sex, underlying cardiac disease, left ventricular ejection fraction, NYHA class assessment and clinical arrhythmia. The results of the DFT testing during follow-up (prehospital discharge test and 1 and 3 years) were compared to the baseline value obtained during the implantation procedure. All lead related complications were analyzed. Eighty-two single element subcutaneous array electrodes (SQ-A1), 31 subcutaneous three-finger electrodes (SQ-A3), and 21 subcutaneous patch electrodes (SQ-P) were implanted during the study period. The median follow-up was 1,499 days (25th percentile: 798 days, 75th percentile: 1,976 days) in the SQ-A1 group, 2,209 days (25th percentile: 1,242 days, 75th percentile: 2,710 days) in the SQ-A3 group, and 1,419 days (25th percentile: 787 days, 75th percentile: 2,838 days) in the SQ-P group. None of the three groups had a significant change of the DFT during follow-up compared to baseline. Major complications occurred in six (7.3%) patients in group SQ-A1 and in two (9.5%) patients in group SQ-P. There were no major complications in group SQ-A3. Kaplan-Meier curves analyzing freedom from subcutaneous lead related complications did not show a significant difference between the three study groups (P = 0.16). SQ-A1, SQ-A3, and SQ-P leads provide stable DFTs during long-term follow-up. Major complications are rare. However, a careful follow-up including chest radiographs at regular intervals is needed to detect potentially fatal complications like lead fractures.

Defibrillators, Implantable↗
PubMed2005

Do implanted pacemaker leads and ICD leads cause metal-related artifact in cardiac PET/CT?

UNLABELLED: Artifacts related to metallic implants are an established limitation of CT-based attenuation correction (CT-AC) in PET/CT. However, the impact of metallic components of pacemaker leads and implantable cardioverter defibrillator (ICD) leads on the accuracy of cardiac PET has not been evaluated. The goal of this study was to investigate the magnitude of artifacts related to pacing and defibrillation leads in both phantom and patient studies. METHODS: Images were acquired on a PET/CT scanner using CT-AC and were compared with those obtained on a dedicated PET scanner using transmission source-based attenuation correction. Phantoms consisting of pacemaker leads and ICD leads submerged in uniform background activity solution were imaged, and regions were analyzed to measure radionuclide concentrations at known lead locations relative to background. In addition, 15 cardiac 18F-FDG patients (having either pacing leads, defibrillation leads, or both) were imaged on both PET/CT and PET scanners. Images were visually and quantitatively assessed to determine whether artifact related to the implanted leads was present and, if so, its severity relative to surrounding myocardium. RESULTS: In phantom studies, artifacts caused by pacing lead electrodes were barely noticeable, but artifacts arising from highly radioopaque ICD shock coil electrodes were clearly apparent. In the patient studies, no artifacts from pacing leads were identified. However, significant artifact was observed in 50% of the patient studies with ICD leads. In the affected areas, local myocardial uptake in PET/CT images using CT-AC was, on average, 30% higher than that in the corresponding PET images. CONCLUSION: Although pacemaker leads do not appear to cause artifact in cardiac PET/CT images, ICD leads frequently do result in artifacts of sufficient magnitude to impact clinical image interpretation. Accordingly, software-based corrections in CT-AC algorithms appear necessary for accurate cardiac imaging with PET/CT.

Artifacts↗
PubMed2004

Beta-adrenergic receptor density and adenylate cyclase activity in lead-exposed rat brain after cessation of lead exposure.

To understanding the reversible or irreversible harm to the beta-adrenergic system in the brain of lead-exposed rats, this study sets up an animal model to estimate the change in the sympathetic nervous system of brain after lead exposure was withdrawn. We address the following topics in this study: (a) the relationship between withdrawal time of lead exposure and brain beta-adrenergic receptor, blood lead level, and brain lead level in lead-exposed rats after lead exposure was stopped; and (b) the relationship between lead level and beta-adrenergic receptor and cyclic AMP (c-AMP) in brain. Wistar rats were chronically fed with 2% lead acetate and water for 2 months. Radioligand binding was assayed by a method that fulfilled strict criteria of beta-adrenergic receptor using the ligand [125I]iodocyanopindolol. The levels of lead were determined by electrothermal atomic absorption spectrometry. The c-AMP level was determined by radioimmunoassay. The results showed a close relationship between decreasing lead levels and increasing numbers of brain beta-adrenergic receptors and brain adenylate cyclase activity after lead exposure was withdrawn. The effect of lead exposure on the beta-adrenergic system of the brain is a partly reversible condition.

Adenylyl Cyclases↗
PubMed2006

Comparison of parental report of blood lead testing in children enrolled in Medicaid with Medicaid claims data and blood lead surveillance reports.

The purposes of this study were to identify the congruence of blood lead testing based on parental self-reports with Medicaid claims and blood lead surveillance records, and to determine factors associated with agreement between parental reports of blood lead tests and Medicaid claims or blood lead surveillance records. Data were obtained from a cross-sectional mailed survey of a randomly selected sample of parents of children 1-2 years old enrolled in Medicaid (n=532) and from existing Medicaid claims and blood lead surveillance records. Fifty-six percent of survey respondents reported their child had a blood lead test completed. Of these, only 56% could be confirmed with Medicaid claims/blood lead surveillance data. Logistic regression analysis revealed the odds of blood lead testing per parental report confirmed with Medicaid claims/blood lead surveillance data were 2.6 times greater if the child had > or =3 provider visits, 2.5 times greater if parents reported receiving a reminder about blood lead testing, 2.2 times greater if parents reported receiving information about lead poisoning, 1.6 times greater if residing in an urban county, and 1.5 times greater if the child was more than 2 years old. In conclusion, parents are not always aware if their child had a blood lead test. Information and reminders about blood lead testing should be distributed to parents of young children enrolled in Medicaid and frequently reviewed by healthcare providers.

Adolescent↗
PubMed1991

The risk of lead toxicity in homes with lead paint hazard.

While lead paint has long been known to be a major source of lead poisoning, only a few small epidemiologic studies have attempted to assess directly the relative risk of lead poisoning due to the presence of lead paint. Using data from over 200,000 screening tests of children in the city of Chicago performed between 1976 and 1980, the relative risks can be quantified for children living in a major urban area. Lead paint was found to be a significant predictor of the probability of a child having lead toxicity. As expected, the reduction in leaded gasoline sales during the period reduced mean blood lead levels and increased the percentage of lead toxic children whose toxicity could be attributed to paint lead. Poisson regression models indicated that with the elimination of leaded gasoline, the relative risk of lead toxicity given lead paint exposure was 5.70 (95% CI, 4.13-7.86) during the winter and fall. The relative risk rose to 12.81 (95% CI, 7.33-22.4) in the spring and 15.8 (95% CI, 8.90-28.1) in the summer, probably due to increased exposure to window wells.

Bayes Theorem↗
PubMedDate not supplied

Maternal perceptions of lead poisoning in children with normal and elevated lead levels.

INTRODUCTION: The purpose of this study was to examine mothers' perceptions of the severity and susceptibility of their children to lead poisoning and to determine if a correlation existed between mothers' knowledge of lead poisoning and their children's blood lead levels. It was thought that mothers of children with lead poisoning (lead levels > or = 10 micrograms/dL) would score lower on a test of their perceptions and knowledge of lead poisoning than would mothers of children with normal lead levels (lead levels < or = 9 micrograms/dL). METHOD: A cross-sectional study comparing scores of a questionnaire completed by mothers whose children had elevated blood lead levels and mothers whose children had normal blood lead levels was conducted. RESULTS: No difference was found in the median test score between the 2 groups. For the correct responses on a question-by-question comparison, significant difference existed between groups; however, the percentage of correct responses was not always greater for the mothers of children with normal blood lead levels. DISCUSSION: Mothers' perceptions and knowledge of lead poisoning were not associated with their children's blood lead levels.

Adult↗
PubMed1989

L-line x-ray fluorescence of cortical bone lead compared with the CaNa2EDTA test in lead-toxic children: public health implications.

Mild to moderate lead toxicity (blood lead, 25-55 micrograms/dl) is a preventable pediatric illness affecting several million preschool children ("lead-toxic children") in the United States. In-hospital lead-chelation treatment is predicated upon a positive CaNa2EDTA test, which is difficult to perform and impractical in large populations. After the development of an L-line x-ray fluorescence technique (LXRF) that measures cortical bone lead content safely, rapidly, and noninvasively, this study was initiated in lead-toxic children to compare LXRF with the CaNa2EDTA test. Moreover, LXRF provided the opportunity to quantify bone lead content. From blood lead and LXRF alone, 90% of lead-toxic children were correctly classified as being CaNa2EDTA-positive or -negative. In 76% of 59 lead-toxic children, bone lead values measured by LXRF were equal to or greater than those measured in normal and industrially exposed adults. These results indicate that LXRF may be capable of replacing the CaNa2EDTA test. When considered with the known neurotoxic effects on children of "low levels" of exposure to lead, these results also suggest that either an excessively narrow margin of safety or insufficient safety is provided by present U.S. guidelines, which classify an elevated blood lead concentration as 25 micrograms/dl or greater.

Bone and Bones↗
PubMed2001

Dorchester Lead-Safe Yard project: a pilot program to demonstrate low-cost, on-site techniques to reduce exposure to lead-contaminated soil.

Despite a general reduction in blood lead levels in children after lead was banned in gasoline and paint, lead poisoning remains an important health problem in many older urban areas. One factor that increases risk in these places is the high levels of lead in certain residential areas. A major intervention study found that reducing lead levels in urban soils results in a reduction in exposed children's blood lead levels. Removing lead from inner-city soils or reducing exposures to lead-contaminated soils typically is expensive, technologically challenging, or beyond the ability of low-income households to undertake. This project, in conjunction with residents and community-based institutions, developed a series of in situ, low-cost, low-technology measures that worked to reduce the exposure to lead-contaminated soils in one Boston, Massachusetts, neighborhood. The project demonstrated several important results. Government, universities, residents, and community based organizations can work together effectively to reduce exposures to lead in soil. Lead-contaminated soil can be mitigated at a fraction of the cost of conventional methods in ways that increase the ability of residents, community health centers, and others to have a positive impact on their neighborhoods. A lead-safe yard program can be replicated and institutionalized by municipal home de-leading programs and other community organizations.

Child↗
PubMed1983

Regressive or lethal lead encephalopathy in the suckling rat. Correlation of lead levels and morphological findings.

Lead encephalopathy was produced in immature Sprague-Dawley rats with an intraperitoneal (IP) injection of 60 micrograms/g body weight of lead acetate administered daily from the fifth day after birth. Macroscopic and light microscopic study of the nervous system, estimations of the blood-brain barrier permeability to proteins and brain water content were performed every two days thereafter. Lead levels in total blood, plasma, and several brain areas were measured at the same intervals by flameless atomic absorption spectrometry. Electron microscopic study of the cerebellum was done 2, 6, and 12 days after beginning lead administration. After two days of lead administration and before any pathological change occurred the increase in lead level was greater in the cerebellum than in other brain areas. After four to six days, hemorrhagic lead encephalopathy developed and was most prominent in regions with higher lead levels. From day 11 to 14, there were two possible courses: a) improvement of the clinical status and morphological findings in 25% of the animals, or b) progression of abnormal clinical signs and death. Cerebral edema, both intra- and extracellular, may have contributed to the fatal evolution. The mechanism of this edema appeared complex and may have involved resorption failure. Good correlations were observed among progression of the clinical signs, high water content in the brain, morphological evidence of cerebral edema, and a high cerebellar lead level. In contrast, high blood lead levels could be associated with clinical improvement, normal brain water content, and regression of the pathological findings. These data suggest that differences in evolution are more likely related to differences in the development of resistance of the cerebral capillary to lead, or in the efflux of lead, rather than to the blood lead concentrations.

Animal Population Groups↗
PubMed2000

A pilot study examining changes in dust lead loading on walls and ceilings after lead hazard control interventions.

The U.S. Department of Housing and Urban Development (HUD) guidelines on lead hazard control instruct contractors to clean floors, windows, walls, ceilings, and other horizontal surfaces to remove lead-contaminated dust and debris after lead interventions are conducted. This dust removal activity adds costs to each project. The need to clean floors and windows is well documented in the HUD guidelines. However, there is substantially less documentation to support the recommendation to clean walls and ceilings. We examined whether it is necessary to clean walls and ceilings after lead hazard control (LHC) interventions by comparing dust lead loadings measured on these surfaces before an LHC intervention to dust lead loadings after the intervention. Twenty-two dwelling units undergoing substantial LHC measures consistent with the HUD guidelines were enrolled in the study. There was a significant increase in dust lead loading on walls and ceilings between the pre- and postintervention. The change in wall dust lead loading was substantial and created potentially harmful lead exposures. Although statistically significant, the change in ceiling dust lead loading was minimal and the postintervention dust lead loadings were far below the existing federal floor dust lead clearance standard. These results strongly support the recommendations in the HUD guidelines to clean walls after LHC interventions and do not provide sufficient justification to alter the current recommendation to clean ceilings after lead work.

Child↗
PubMed2003

Effects of calcium disodium EDTA and meso-2,3-dimercaptosuccinic acid on tissue concentrations of lead for use in treatment of calves with experimentally induced lead toxicosis.

OBJECTIVE: To compare the efficacy of calcium disodium EDTA (CaNa2EDTA) and meso-2,3-dimercaptosuccinic acid (DMSA) in reducing concentrations of lead in selected tissues for use in treatment of calves with experimentally induced lead toxicosis. ANIMALS: 19 sexually intact male Holstein calves that weighed 35 to 60 kg. PROCEDURE: Calves were randomly assigned to 1 of 5 treatment groups: group 1, control calves; group 2, lead only; group 3, lead and EDTA; group 4, lead and DMSA; and group 5, lead, EDTA, and DMSA. Calves in groups 2 to 5 were dosed daily with lead (5 mg/kg, PO) for 10 days. Doses of EDTA (100 mg/kg) and DMSA (25 mg/kg) were administered IV once daily for 4 consecutive days beginning on day 11. Effects of the chelators on lead concentrations in the liver, kidneys, testes, muscles, bones, and brain were compared among the various groups. RESULTS: Compared with the effects of EDTA, DMSA greatly reduced lead concentrations in renal and hepatic tissues. We did not detect significant differences for the effects of EDTA or DMSA on lead concentrations in the testes; there was an adverse interaction of EDTA with DMSA that caused an increase in lead concentrations in the testes. CONCLUSIONS AND CLINICAL RELEVANCE: DMSA is much more effective than EDTA in removing lead from renal and hepatic tissues in calves. Use of DMSA in calves with lead intoxication appears to be a viable treatment option. Combining DMSA and EDTA as a treatment modality in calves did not offer any advantages.

Animals↗
PubMed1984

Lead toxicity and metabolism from lead sulfate fed to Holstein calves.

Sixteen Holstein intact male calves averaging 85 kg and 74 days of age were assigned randomly to four dietary lead treatments according to body weight. They were fed for ad libitum consumption a control diet containing no added lead or the control diet supplemented with 500, 1500, or 4500 ppm lead as lead sulfate. One calf fed 1500 ppm lead and all four calves fed 4500 ppm lead died within 6 to 10 days after initiation of treatments. Death was sudden with few or no clinical signs prior to death. Those clinical signs that did appear included muscular tremors, gnashing of teeth, bellowing, and convulsions. Four control, four 500 ppm lead, and two 1500 ppm lead-fed calves survived the 7-wk experimental period. Feed consumption, body weight changes, glutamic oxaloacetic transminase and alkaline phosphatase activity in blood plasma, and hemoglobin were not affected significantly by lead treatments. Packed cell volume in calves fed 500 and 1500 ppm added lead was reduced. Lead concentrations in blood, kidney, liver, bone, brain, and muscle were elevated in lead supplemented calves above those of controls. The highest concentrations of lead were in kidney and liver.

Animals↗
PubMed1999

[Comparison of children's blood lead levels in Shanghai before and after the introduction of lead free gasoline].

OBJECTIVE: To determine the blood lead levels of children before and after the introduction of lead free gasoline in Shanghai. METHODS: We measured the blood lead levels in 1972 children in Shanghai before the introduction of lead free gasoline in Shanghai. The blood lead levels of those children were re-determined 6 months after the leaded gasoline was phased out. RESULTS: After leaded gasoline was phased out, geometric mean of blood lead levels was decreased significantly from 83 micrograms/L to 80 micrograms/L. The prevalence rate of childhood lead poisoning (blood lead level equal to or more than 100 micrograms/L) decreased from 37.8% to 25.7%. CONCLUSIONS: The introduction of lead free gasoline could decrease children's blood lead levels in Shanghai. However, the magnitude of decrease is not as great as expected, suggesting that more environmental interventions, such as industry emission control, are needed to prevent childhood lead poisoning.

Child↗
PubMed2003

The association of lead-contaminated house dust and blood lead levels of children living on a former landfill in Puerto Rico.

Exposure to lead in children living on a former landfill in Vega Baja-Puerto Rico, a United States Environmental Protection Agency (USEPA) designated Superfund Site, is a major health concern. Direct contact with lead-contaminated soil is considered a major exposure source. However, there is a lack of information regarding the contribution of lead-contaminated house dust to children's blood lead concentrations. This study evaluated the relationship between lead contaminated-house dust and children's blood lead levels. Blood from 42 children, aged 6 years old or less, and dust from 29 houses were analyzed for lead, and face-to-face interviews were performed to gather information on potential risk factors for high blood lead levels. Blood lead levels ranged from 0.97 to 7.79 micrograms/dL. Lead values for floors fluctuated from 0.12 to 98.30 micrograms/ft2, with 17% of houses surpassing the USEPA standard of 40 micrograms/ft2. Multiple regression analysis showed that lead in window sills, toy chewing and soil eating habits were significant predictors of blood lead levels. Further investigations aimed at assessing the long-term effects of constant exposure to environmental lead in these children are warranted.

Air Pollution, Indoor↗
PubMed1994

Do questions about lead exposure predict elevated lead levels?

OBJECTIVE: To assess the usefulness of the lead poisoning questionnaire developed by the Centers for Disease Control and Prevention as a screening tool for elevated lead levels. METHODS: This descriptive study used a five-question questionnaire at our hospital-based general pediatric clinic and in two local private practices. We obtained venous lead levels from 485 children aged 9 months to 6 years who were brought for health supervision visits. The questionnaire was completed by a primary caretaker of 330 patients (68%). Contingency tables were used to compare lead levels with the responses on the questionnaire. RESULTS: Lead levels of > or = 10 micrograms/dL were found in 23 (7%) of 330 who completed the questionnaire. Caretakers of children with elevated lead levels were more likely to answer yes to questions about chipping paint and home remodeling than those whose children had levels < 10 (P = .0001). These questions had sensitivities for detecting elevated lead levels of 70% and 74% with negative predictive values of 97% and 98%, respectively. Questions about known contacts with lead poisoning and job or industrial exposure to lead each had sensitivities of < 10%. The Centers for Disease Control and Prevention's definition of high risk for lead poisoning (one or more positive responses) was nearly 90% sensitive for detecting elevated lead levels with a negative predictive value of 99%. CONCLUSION: This risk assessment questionnaire is an effective screening method for elevated lead levels in our population. Questions about the home environment were more sensitive indicators of elevated lead levels than other standard high-risk questions.

Centers for Disease Control and Prevention, U.S.↗