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Stanley J. Schaffer, MD, MS; James R. Campbell, MD, MPH; Peter G. Szilagyi, MD, MPH; Michael Weitzman, MD

Arch Pediatr Adolesc Med. 1998;152:185-189.

Objectives  As part of their training, pediatric residents provide primary care services to young children, including youngsters who may have elevated blood lead levels. We set out to (1) determine the percentage of pediatric residents who screen children for elevated blood lead levels according to the guidelines of the Centers for Disease Control and Prevention and the American Academy of Pediatrics; (2) assess the likelihood of lead screening by residents based on demographic and practice-setting characteristics; and (3) compare the attitudes of residents who report that they are universal screeners, selective screeners, or nonscreeners.

Design  Confidential, cross-sectional survey of a nationally representative sample of pediatric residents conducted as part of the American Academy of Pediatrics 28th Periodic Survey of Fellows.

Subjects  One hundred forty-three responding pediatric residents (51% response rate).

Results  Seventy-five percent of pediatric residents reported screening all patients aged 9 to 36 months for elevated blood lead levels, 21% reported screening some, and 4% reported screening none. Pediatric residents who cared for patients in urban settings were more likely to report screening patients for elevated blood lead levels than were pediatric residents who cared for patients in suburban or rural settings (100% vs 73%; P<.001), and pediatric residents in the Northeast were more likely to report screening universally than were residents in the rest of the country (93% vs 63%; P<.001). Overall, pediatric residents who reported screening patients universally were more likely to believe that the benefits of screening outweigh the costs than were residents who reported screening patients selectively (67% vs 17%; P<.001).

Conclusions  Most pediatric residents reported that they screened patients for elevated blood lead levels, either universally or selectively. Nevertheless, the screening practices of pediatric residents and their opinions concerning the relative benefits and costs of lead screening largely reflect the areas of the country and the practice settings in which they had their primary care experiences.

From the Division of General Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.

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