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PubMed1991

Influence of high past lead-in-air exposures on the lead-in-blood levels of lead-acid battery workers with continuing exposure.

We investigated the relationship between air lead levels and blood lead levels in 132 lead-acid battery workers in two plants who were followed for 30 months between 1983 and 1985 with frequent air lead and blood lead determinations. Both plants converted to more modern, expanded-metal battery manufacturing technologies around 1978 with associated reductions in mean air lead exposures from greater than 100 to less than 30 micrograms/m3. In multiple regression analyses including consideration of job category, seniority, age, ethnicity, gender, and smoking habit as covariates, there was a highly significant association of blood lead in micrograms/dL with air lead in micrograms/m3 (partial R2 = .20, P less than .0001) among the 68 workers in plant B but no association (P = .91) in plant A. Restriction of the regression analysis to those 44 workers in plant B with less than or equal to 22 years of seniority yielded the most significant air lead-blood lead association (partial R2 = .36, P less than .0001). Among the remaining 24 plant B workers, seniority, but not air lead, had a significant positive association with blood lead. Despite very stable air lead levels over the 30-month study, the 51 workers in plant A with more than 20 years' seniority had a mean decline of 0.04 microgram/dL in mean blood lead over the study period, whereas the 13 workers in plant A with less than or equal to 20 years' seniority had a mean increase of 7.6 microgram/dL.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants, Occupational↗
PubMed1985

Prediction of response of blood lead to airborne and dietary lead from volunteer experiments with lead isotopes.

To predict the response of blood lead to airborne and dietary lead requires knowledge of the rate of uptake of lead into the body from lung and gut, its subsequent partitioning between compartments, the stay time in those compartments, and its redistribution or excretion. Tracer studies with volunteers have shown no differences in systemic distribution of inorganic lead between tissues whether it is taken by inhalation, ingestion or injection. Lead is rapidly transferred from plasma to red cells, and there is slower movement thence into liver and other soft tissues, to bone, and to excreta. Work at Harwell and elsewhere with 203Pb has shown that the initial rapid distribution leaves rather over half the assimilated lead attached to red cells. The result is remarkably consistent, and applies also to dogs and baboons. The renal clearance (Vu) (ratio of U to CB, or daily urinary output expressed as mass of blood having the same lead content), and also the endogenous faecal clearance excretion rate (Vf), have been measured on human subjects with 203Pb. The results are consistent with Vu, as measured with stable lead, with many results giving Vu about 0.1 kg d-1. However, there is evidence that Vu increases when CB is elevated above the normal. This may explain the nonlinear relation between uptake of lead and the corresponding CB, which has been observed in humans exposed to environmental lead. Vf is about half Vu, and a similar result applies to calcium. The clearance rate Va of 203Pb from blood to bone has been measured, and a variety of human and animal data in the literature has been reviewed to support this result. Combined with bone turnover rates (from data on 90Sr), the postulated inputs to bone give estimates of skeletal burdens which agree with post-mortem results. The results are combined in a compartment model. The retention of lead aerosol in the lung, and uptake from the gut are then considered, with use made of radioactive tracer (203Pb), stable isotopic tracer (204Pb) and total lead measurements. Here there is great diversity of results. Particle size affects the fractional lung retention and the site of retention, which in turn affects the fractional uptake to blood. Presence or absence of food in the stomach when lead is ingested greatly affects the fractional gut uptake. Finally, a limited selection of results of volunteer exposures to stable lead in air or diet are reviewed.(ABSTRACT TRUNCATED AT 400 WORDS)

Air Pollutants↗
PubMed1995

Survey of New Jersey schools and day care centers for lead in plumbing solder. Identification of lead solder and prevention of exposure to drinking water contaminated with lead from plumbing solder.

Levels of lead in drinking water can be high enough to pose a potential health threat to very young children, primarily from the use of lead solder for indoor plumbing. In February 1987, New Jersey banned lead solder for use in the installation or repair of drinking water plumbing systems. However, because lead solder continued to be available for purchase in the state, New Jersey Department of Health staff sought to (i) determine the extent to which schools and day care centers were in compliance with the ban, and (ii) determine the effectiveness of a solder analysis test kit commonly used by plumbing inspectors in the field. Samples of solder were collected from 53 day care centers and 37 schools known to have been constructed or renovated after the ban took effect. Samples from 24% of those facilities constructed or renovated just after the lead ban (1987-1988) tested positive for lead content. However, for those facilities constructed or renovated in later years (1989-1992), there was a decline in the percentage of samples that tested positive for lead content. For this period of time, 13% of the samples tested positive for lead. In total, more than 10% of facilities with new plumbing installed between 1987 and 1992 had solder samples that tested positive for lead. A lead in solder test kit commonly used by inspectors proved to be an effective screening tool for the field. The New Jersey Department of Health recommends continued enforcement of the lead solder ban through inspection and encouragement of behaviors that minimize consumption of potentially lead-contaminated drinking water. In order to assess patterns of water use, staff at the day care centers were asked to complete a questionnaire. Sixty-seven percent of the respondents reported that they "always" use water from the cold tap when preparing drinks or food for the children. In addition, 57% reported that they always first flush the tap before using the water for drinking or food purposes. Posters and pamphlets developed by the department and containing recommendations for how to minimize consumption of lead-contaminated drinking water were also provided.

Day Care, Medical↗
PubMed1987

Children's blood lead and exposure to lead in household dust and water--a basis for an environmental standard for lead in dust.

Good quantitative evidence on the role of lead in household dust as a source of exposure to children has been lacking. A study of 495 children in Edinburgh, Scotland shows a significant relationship between lead in dust vacuumed from the floors of the children's homes and their blood lead levels. A multiple regression analysis incorporating drinking water and household dust estimates that a 1,000 micrograms g-1 increase in dust lead concentration would increase blood lead by 1.9 micrograms dl-1, for a child with the median population blood lead of 10.1 micrograms dl-1. Dust lead concentration is a more useful predictor of blood lead than lead loading. The sanding or blow-lamp stripping of old paint is found to be an important source of the higher household dust lead concentrations. Finally, the dust lead-blood lead relationship is used to derive a standard for lead in house dust, as no such standard exists for this exposure route.

Child↗
PubMedDate not supplied

Different associations of blood lead, meso 2,3-dimercaptosuccinic acid (DMSA)-chelatable lead, and tibial lead levels with blood pressure in 543 former organolead manufacturing workers.

In this study, the authors' objective was to determine the influence of blood lead, meso 2,3-dimercaptosuccinic acid (DMSA)-chelatable lead, and tibial lead on systolic and diastolic blood pressures and on hypertension in 543 former organolead manufacturing workers. All workers had past exposure to inorganic and organic lead. The authors used linear regression to model systolic and diastolic blood pressure separately, and logistic regression was used for the modeling of hypertension status (i.e., systolic blood pressure > 160 mm Hg, diastolic blood pressure > or =96 mm Hg, or current use of antihypertensive medications). Blood lead, DMSA-chelatable lead, and tibial lead levels had means (standard deviations appear within parentheses) of 4.6 microg/dl (2.6 microg/dl), 19.3 microg (17.2 microg), and 14.4 microg/g (9.3 microg/g), respectively. The authors adjusted for covariates, and they found that blood lead was a predictor of (1) both systolic and diastolic blood pressures and (2) hypertension status in men < 58 y of age. DMSA-chelatable lead and tibial lead were not associated with any of the blood pressure measures. Systolic blood pressure was elevated by blood lead levels as low as 5 microg/dl. We speculate that lead may have a transient influence on blood pressure that is related to target dose levels obtained once release of lead from body stores has occurred.

Adult↗
PubMed2003

Does lead interfere with hemoglobin-based oxygen carrier (HBOC) function? A pilot study of lead concentrations in three approved or tested HBOCs and oxyhemoglobin dissociation with HBOCs and/or bovine blood with varying lead concentrations.

UNLABELLED: We measured lead concentrations in three hemoglobin-based oxygen carriers (HBOCs; Oxyglobin, Hemopure, and Hemolink) and compared them with lead concentrations from blood-bank blood. Oxyhemoglobin dissociation was measured with large concentrations of lead in bovine HBOC, with or without bovine blood, and in bovine blood. Samples of each were prepared by combining one with normal saline (control), the second with small lead concentrations (22 micro g/dL), and the third with toxic lead concentrations (70 micro g/dL). They were blended in 2 tonometers at oxygen concentrations (2.5%, 5%, 8%, 10%, 21%, and 95%) with 5% CO(2) and the remainder nitrogen for 5 min per sample after a 15-min wash-in with each level of oxygen and were measured with co-oximetry. Oxygen saturation was plotted against PO(2), fitting fourth-order polynomial nonlinear regression to the data. The lead concentrations of the three HBOCs were 0.51, 0.22, 0.40 micro g/dL. There were no clinically important differences of the oxyhemoglobin dissociation curves as a function of lead concentration. The lead concentrations of the three tested HBOCs were small and no larger than the average for blood-bank blood. The presence of increasing concentrations of lead in either concentrated solution of bovine HBOC or a 1:1 mixture of bovine HBOC and native bovine blood does not appear to affect hemoglobin oxygenation in an acute in vitro model of increased lead concentrations. IMPLICATIONS: Gunshot wounds rapidly increase circulating lead concentrations. Lead concentrations are small in three hemoglobin-based oxygen carriers (HBOCs), and HBOCs and/or bovine blood do not appear to be affected by lead concentrations in terms of immediate oxygen on-loading and off-loading. HBOCs may be useful in patients with gunshot wounds.

Animals↗
PubMed2002

Assessment of cleaning to control lead dust in homes of children with moderate lead poisoning: treatment of lead-exposed children trial.

In this article we describe the assessment and control of lead dust exposure in the Treatment of Lead-exposed Children (TLC) Trial, a clinical trial of the effects of oral chelation on developmental end points in urban children with moderately elevated blood lead levels. To reduce potential lead exposure from settled dust or deteriorated paint during the drug treatment phase of the trial, the homes of 765 (98%) of the randomized children (both active and placebo drug treatment groups) were professionally cleaned. Lead dust measurements were made in a sample of 213 homes before and after cleaning. Geometric mean dust lead loadings before cleaning were 43, 29, 308, and 707 micro g/ft2 in the kitchen floor, playroom floor, playroom windowsill, and playroom window well samples respectively. Following cleaning, floor dust lead loadings were reduced on average 32% for paired floor samples (p < 0.0001), 66% for windowsills (p < 0.0001), and 93% for window wells (p < 0.0001). Cleaning was most effective for 146 homes with precleaning dust lead levels above the recommended clearance levels, with average reductions of 44%, 74%, and 93% for floors (p < 0.0001), windowsills (p < 0.0001), and window wells (p < 0.0001), respectively. Despite these substantial reductions in dust lead loadings, a single professional cleaning did not reduce the lead loadings of all dust samples to levels below current federal standards for lead in residential dust. Attainment of dust levels below current standards will require more intensive cleaning and lead hazard reduction strategies.

Chelating Agents↗
PubMed2003

A randomized trial of education to prevent lead burden in children at high risk for lead exposure: efficacy as measured by blood lead monitoring.

In this article we report on the effectiveness of a community-based, culture-specific, controlled trial of intensive peer education aimed at preventing lead burden in children 0-36 months of age within a neighborhood with high risk for lead exposure. Mothers (n = 594) were randomly assigned to control or intervention groups. Offspring blood lead levels were assessed every 4 months. All participants received brochures on basic lead prevention strategies. Intervention participants were offered 20 bi-weekly educational sessions by same-ethnicity peer educators over the course of 1 year, and quarterly booster sessions for 2 years afterward. The intervention group's educational curriculum included information on lead sources (e.g., paint, dust, water, soil, and risks from home repairs and remodeling), health consequences of lead burden, and strategies to reduce lead exposure, including household cleaning, hygiene, safe use of water, and nutritional recommendations. Results indicated that of the 378 children contributing sufficient blood data for analysis, 23% had blood lead levels > 10 micro g/dL before 3 years of age. Intervention participants were more likely to maintain blood lead levels < 10 micro g/dL than were controls (81% vs. 73%; p = 0.08). Multivariate analyses demonstrated that the intervention reduced the risk of blood lead levels > 10 micro g/dL by approximately 34%. We conclude that although intensive education resulted in a lower proportion of children with elevated lead levels, education alone cannot be relied upon to prevent lead burden.

Adult↗
PubMed2001

Associations of tibia lead, DMSA-chelatable lead, and blood lead with measures of peripheral nervous system function in former organolead manufacturing workers.

BACKGROUND: The goals of the present study were to compare and contrast associations of blood lead, DMSA-chelatable lead, current tibia lead, and back-extrapolated "peak" tibia lead with four peripheral nervous system (PNS) sensory and motor function measures in older males with past exposure to organic and inorganic lead. METHODS: Data were collected from former organolead manufacturing workers with an average of 16 years since last occupational lead exposure. Current tibia lead levels were measured by (109)Cd x-ray fluorescence. Sensory pressure thresholds (index and pinky fingers) and pinch and grip strength were measured with the Pressure-Specified Sensory Device (PSSD). RESULTS: In adjusted analyses, none of the four lead biomarkers was associated with sensory pressure threshold of the index finger or pinch or grip strength. In contrast, all four biomarkers were associated (P < or = 0.10) with pressure threshold of the pinky finger. The final linear regression models accounted for a small proportion of the variance in the sensory (1-3%) and motor measures (10-21%). CONCLUSIONS: This study found no strong association between lead biomarkers and selected PNS sensory or motor function measures among former organolead manufacturing workers with no recent occupational exposure to lead. Previously reported CNS findings in this cohort suggest that the PNS may be less sensitive to the chronic toxic effects of lead in this dose range among adults. It is also possible that the PNS has a greater capacity for repair than does the CNS, or that the PNS measures were less sensitive for detection of lead-related health outcomes than were the CNS measures.

Adult↗
PubMed1978

X-ray fluorescence analysis of lead in teeth of urban children in situ: correlation between the tooth lead level and the concentration of blood lead and free erythroporphyrins.

The tooth lead level of 30 lead-exposed children was measured in situ using an X-ray fluorescence technique. The tooth lead concentration divided by the child's age correlated with the free erythroporphyrin (FEP) (r = 0.51) and the blood lead levels (r = 0.31). The mean tooth lead concentrations of 10 Class IV children (FEP greater than or equal to 190 micrograms/100 ml; blood lead 30-80 micrograms/ml) was 14.5 +/- 5.5 ppm/year. Reexamination of the histories of children who had been classified as Class II or III, but who had tooth lead concentrations within 1 SD of the Class IV level, indicated that many of these children could also be considered to be Class IV children. When the x-ray fluorescence technique was used to screen an urban population of 300 children, the tooth lead values indicated that 72% of the children had been exposed to low levels of environmental lead. Six percent of the children were found to have tooth lead concentrations in excess of 9 ppm/year and within 1 SD of the mean value exhibited by Class IV children. These children were considered to have a high body lead burden. The percentage of children having an elevated tooth lead level is similar to the number previously reported using exfoliated deciduous teeth.

Child↗
PubMed2005

The influence of common area lead hazards and lead hazard control on dust lead loadings in multiunit buildings.

Owners of multiunit buildings built before 1978 that have interior common areas, and who receive certain forms of federal assistance are generally required to address lead-based paint hazards in those common areas. This study examines the relationships between common area paint and dust lead levels and the floor dust lead loadings in associated dwelling units, as well as the effects of lead hazard control treatments in common areas. This article presents data from common areas in 145 low-income, mostly pre-1940, multiunit buildings with 342 associated dwellings in the U.S. Department of Housing and Urban Development Lead Hazard Control Grant Program at preintervention, clearance, and 1-year postintervention. Interior common areas in these multiunit buildings were not as well maintained as the dwellings in the buildings. At preintervention, a higher percent of the interior common areas had non-intact, lead-based paint on windows, doors and trim, and other interior components than in associated dwellings (95% versus 85%; 78% versus 67%; and 85% versus 62%). Common areas had preintervention entry and interior (i.e., nonentry) floor dust lead loadings more than four times higher than in dwelling units (128 versus 30 micro g/ft(2); 130 versus 28 micro g/ft(2)) while 1-year postintervention common area dust lead loadings are four to six times that of dwelling dust lead loadings (41 versus 11 micro g/ft(2); 44 versus 8 micro g/ft(2)). Windowsill dust lead loadings in common areas were twice the loadings in dwelling units at preintervention and 1-year postintervention (756 versus 383 mu g/ft(2); 154 versus 68 micro g/ft(2)). Interior common area treatments reduced geometric mean common entry dust lead loadings 71% from preintervention to clearance, and maintained those reduced levels from clearance to 1-year postintervention. Higher level interventions were not more effective than low-level interventions in reducing preintervention levels to clearance or 1-year postintervention. This study demonstrates that interior common areas in the multiunit buildings examined contain substantial amounts of deteriorated lead-based paint and dust. Remediation of common areas can effectively reduce those hazards.

Air Pollution, Indoor↗
PubMed1999

Estimation of post-lead-time survival under dependence between lead-time and post-lead-time survival.

Early detection of cancer by screening advances the date of diagnosis, but may or may not alter time to death. Screening programme need to assess the true benefit of screening, that is, the length of time by which survival has been extended, beyond merely the time by which the diagnosis is advanced (lead-time). One method is to estimate the distribution of the time survived post-lead-time using total survival time data for screen-detected cancer cases, under the assumption of independence of the lead-time and the past-lead-time survival. However, it seems biologically reasonable that the lead-time and the post-lead-time survival are positively correlated. This paper investigates the consequences of departures from independence of lead-time and post-lead-time survival on estimation of post-lead-time survival. We introduce a new model that involves dependence between the lead-time and the post-lead-time survival. We show that the new model can be converted to the model discussed by Xu and Prorok. We consider the non-parametric maximum likelihood estimator of the post-lead-time survival under the new model. We apply the method to data from the HIP (Health Insurance Plan of Greater New York) breast cancer screening trial. We make comparisons with the survival of cancer cases not detected by screening, such as interval cases, cases among individuals who refused screening, and randomized control cases.

Breast Neoplasms↗
PubMed2004

Twelve-lead electrocardiogram: the advantages of an orderly frontal lead display including lead -aVR.

BACKGROUND: It is possible that efforts in ECG review by both young experienced clinicians are currently discouraged-and risk to be completely dismissed-by the conventional (ie, disorderly) display of the frontal plane leads, with lead aVR at -150 degrees. METHODS: We reviewed studies on the usefulness of leads aVR and -aVR as well as on the history of the frontal leads in electrocardiography. RESULTS: Lead aVR and particularly, lead -aVR, provide useful information when systematically analyzed. In addition, if lead -aVR is examined in its anatomically logical sequence, ie, aVL, I, -aVR, II, aVF, and III, the frontal plane of the 12-lead ECG is more easily understood. This "panoramic" or "orderly" display is in common use in countries such as Sweden, but it is rarely seen in the United States. CONCLUSIONS: ECG interpretation would be enhanced by displaying the limb leads in an orderly arrangement that starts with lead aVL and ends with lead III, and many ECG changes would be ideally displayed by a lead -aVR at 30 degrees.

Arrhythmias, Cardiac↗
PubMed2001

Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V(1).

OBJECTIVES: We sought to determine the electrocardiographic (ECG) features associated with acute left main coronary artery (LMCA) obstruction. BACKGROUND: Prediction of LMCA obstruction is important with regard to selecting the appropriate treatment strategy, because acute LMCA obstruction usually causes severe hemodynamic deterioration, resulting in a less favorable prognosis. METHODS: We studied the admission 12-lead ECGs in 16 consecutive patients with acute LMCA obstruction (LMCA group), 46 patients with acute left anterior descending coronary artery (LAD) obstruction (LAD group) and 24 patients with acute right coronary artery (RCA) obstruction (RCA group). RESULTS: Lead aVR ST segment elevation (>0.05 mV) occurred with a significantly higher incidence in the LMCA group (88% [14/16]) than in the LAD (43% [20/46]) or RCA (8% [2/24]) groups. Lead aVR ST segment elevation was significantly higher in the LMCA group (0.16 +/- 0.13 mV) than in the LAD group (0.04 +/- 0.10 mV). Lead V(1) ST segment elevation was lower in the LMCA group (0.00 +/- 0.21 mV) than in the LAD group (0.14 +/- 0.11 mV). The finding of lead aVR ST segment elevation greater than or equal to lead V(1) ST segment elevation distinguished the LMCA group from the LAD group, with 81% sensitivity, 80% specificity and 81% accuracy. A ST segment shift in lead aVR and the inferior leads distinguished the LMCA group from the RCA group. In acute LMCA obstruction, death occurred more frequently in patients with higher ST segment elevation in lead aVR than in those with less severe elevation. CONCLUSIONS: Lead aVR ST segment elevation with less ST segment elevation in lead V(1) is an important predictor of acute LMCA obstruction. In acute LMCA obstruction, lead aVR ST segment elevation also contributes to predicting a patient's clinical outcome.

Acute Disease↗
PubMed1994

The impact of soil lead abatement on urban children's blood lead levels: phase II results from the Boston Lead-In-Soil Demonstration Project.

The Boston Lead-In-Soil Demonstration Project was a randomized environmental intervention study of the impact of urban soil lead abatement on children's blood lead levels. Lead-contaminated soil abatement was associated with a modest reduction in children's blood lead levels in both phases of the project; however, the reduction in Phase II was somewhat greater than that in Phase I. The combined results from both phases suggest that a soil lead reduction of 2060 ppm is associated with a 2.25 to 2.70 micrograms/dl decline in blood lead levels. Low levels of soil recontamination 1 to 2 years following abatement indicate that the intervention is persistent, at least over the short-term. Furthermore, the intervention appears to benefit most children since no measurable differences in efficacy were observed for starting blood and soil lead level, race, neighborhood, gender, and many other characteristics. However, soil abatement did appear to be more beneficial to children in the higher socioeconomic classes, with low baseline ferritin levels, and who spent time away from home on a regular basis and lived in nonowner occupied housing, and with adults who had lead-related hobbies and almost always washed their hands before meals. Children who lived in apartments with consistently elevated floor dust lead loading levels derived almost no benefit from the soil abatement. It was not possible to separate the effects of the variables that had a beneficial impact on efficacy because they were closely correlated and the number of subjects was small. We recommend that further research be conducted to identify subgroups of children to whom soil lead abatement might be targeted.

Boston↗
PubMed1989

Determination of numbers of lead-exposed American children as a function of lead source: integrated summary of a report to the U.S. Congress on childhood lead poisoning.

In 1986, the U.S. Congress [Section 118(f), Superfund Amendments and Reauthorization Act (SARA)] directed the Agency for Toxic Substances and Disease Registry to provide to it a quantitative assessment of the contributions of various sources of lead to childhood exposure. We provided both a quantitative response to the mandate and a critique of low-level lead sources for U.S. population segments. We also present here an integrated assessment of major and low-level lead sources. Significant sources of lead in childhood exposure include lead in paint, dust, soil, and drinking water. Approximately 6 million U.S. children less than 7 years old reside in the oldest housing, with highest exposure risk due to leaded paint. About 2 million in deteriorated units are at particularly high risk for exposure with ca. 1.2 million children in oldest, deteriorated housing estimated to have blood lead (PbB) levels above 15 micrograms/dl. Soil and dust lead are potential sources of exposure for 6-12 million children. Residential tap water lead is a measurable source for ca. 3.8 million children, of whom the U.S. EPA estimates ca. 240,000 have water-specific exposures at toxic levels. Leaded gasoline combustion mainly in past years has produced, and will continue to produce into the 1990s, significant numbers of exposed children with toxicologically elevated PbBs. For 1990, 1.25 million children will have their PbBs fall below 15 micrograms/dl. Food lead can cause significant exposure in certain cases.

Child↗
PubMed2005

Associations of patella lead and other lead biomarkers with renal function in lead workers.

OBJECTIVE: We sought to compare associations of patella lead, which may represent a unique cumulative and bioavailable lead pool, with other lead measures in models of renal function. METHODS: Renal function measures included blood urea nitrogen, serum creatinine, measured and calculated creatinine clearances, and urinary N-acetyl-beta-D-glucosaminidase (NAG) and retinol-binding protein. RESULTS: In 652 lead workers, mean (SD) blood, patella, and tibia lead were 30.9 (16.7) microg/dL, 75.1 (101.1) and 33.6 (43.4) microg Pb/g bone mineral, respectively, and were correlated (Spearman's r = 0.51-0.74). Patella lead was associated (P < 0.05) with NAG in all lead workers. In models of effect modification by age, higher patella lead also was associated with higher serum creatinine in older participants. Similar associations were observed for blood and tibia lead. CONCLUSIONS: Associations between patella lead and adverse renal outcomes were not unique; this may be due, in part, to high correlations among the lead biomarkers in this study.

Adult↗
PubMed2003

The relative accuracies of ECG precordial lead waveforms derived from EASI leads and those acquired from paramedic applied standard leads.

Accurate precordial electrode placement can be difficult in emergency situations leading either to loss of time or diminished accuracy. A possible solution is the quasi-orthogonal EASI lead system, with only five electrodes and easily defined landmarks to provide a derived 12-lead electrocardiogram (ECG). The purpose of this study was to test the hypothesis that precordial waveforms in EASI-derived ECGs have no greater deviation from those in gold standard ECGs, than do the precordial waveforms in paramedic acquired standard ECGs. Twenty paramedics applied the standard precordial electrodes employing the routine procedure. A certified ECG technician applied the 6 standard precordial electrodes in their correct gold standard positions, and the EASI electrodes. 12-lead ECGs were obtained from the paramedics' standard leads, and derived from the EASI leads, for comparison with the gold standard ECG. In each precordial lead recording, 6 computer-measured QRS-T waveform parameters were considered. Differences between deltaEASI-gold standard versus deltaparamedic-gold standard were calculated for every waveform in every lead resulting in 720 comparisons. EASI and paramedic results were "equally accurate" in 47%, the paramedic was more accurate in 31%, and EASI was more accurate in the remaining 22%. The differences from gold standard recording of precordial waveforms in ECGs derived from the EASI leads and those acquired via paramedic-applied standard electrodes are similar. The results suggest that the EASI lead system may provide an alternative to the standard ECG precordial leads to facilitate data acquisition and possibly save valuable time in emergency situations.

Electrocardiography↗