Utility of a risk assessment questionnaire in identifying children with lead exposure
M. A. Dalton, J. D. Sargent and T. A. Stukel
Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
OBJECTIVE: To evaluate the utility of the Centers for Disease Control and
Prevention (CDC) Risk Questionnaire and a behavioral risk factor
questionnaire in identifying children with blood lead concentrations of
0.48 mumol/L (10 micrograms/dL) or more. DESIGN: Cross-sectional study of
463 urban Massachusetts children (6 to 72 months of age) screened for lead
with venous blood. RESULTS: Twenty-two percent of the children had elevated
blood lead concentrations. Of the five CDC questions, only one was
significantly associated with an increased adjusted odds ratio for elevated
blood lead: having a sibling, housemate, or playmate who was followed up or
treated for lead poisoning (odds ratio, 2.7; 95% confidence interval, 1.7
to 4.2; P < .001). Children who had at least one positive or equivocal
response to any of the five CDC questions (n = 318 [68.7%]) were not at
higher risk than were children who displayed a negative response to all
five questions (odds ratio, 1.1; 95% confidence interval, 0.7 to 1.8; P =
.69). Of nine behaviors surveyed, two were associated with an increased
adjusted odds for elevated blood lead: use of a pacifier (odds ratio, 2.4;
95% confidence interval, 1.3 to 4.4; P = .01) and playing near the outside
of the home (odds ratio, 3.4; 95% confidence interval, 2.0 to 5.8; P <
.001). CONCLUSIONS: In this population of children, the CDC risk
questionnaire did not identify a group at higher risk for lead exposure. We
suggest that practitioners in urban communities screen all children
according to the same schedule. We conclude that risk factors differ by
community and no risk questionnaire developed at the national level should
be applied across communities to target screening.
