Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1867-e1895 (doi:10.1542/10.1542/peds.2006-2284)
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SPECIAL ARTICLE

Screening for Elevated Lead Levels in Childhood and Pregnancy: An Updated Summary of Evidence for the US Preventive Services Task Force

Gary Rischitelli, MD, JD, MPHa,b, Peggy Nygren, MAa, Christina Bougatsos, BSa, Michele Freeman, MPHa and Mark Helfand, MD, MPHa

a Oregon Evidence-Based Practice Center
b Center for Research on Occupational and Environmental Toxicology, Oregon Health & Science University, Portland, Oregon

BACKGROUND. In 1996, the US Preventive Services Task Force provided recommendations for routine screening of asymptomatic children and pregnant women for elevated blood lead levels. This review updates the evidence for the benefits and harms of screening and intervention for elevated blood lead in asymptomatic children and pregnant women.

METHODS. We searched Medline, reference lists of review articles, and tables of contents of leading pediatric journals for studies published in 1995 or later that contained new information about the prevalence, diagnosis, natural course, or treatment of elevated lead levels in asymptomatic children aged 1 to 5 years and pregnant women.

RESULTS. The prevalence of elevated blood lead levels among children and women in the United States, like that in the general population, continues to decline sharply, primarily because of marked reductions in environmental exposure, but still varies substantially among different communities and populations. Similar to the findings in 1996, our searches did not identify direct evidence from controlled studies that screening children for elevated blood lead levels results in improved health outcomes, and there was no direct evidence identified from controlled studies that screening improves pregnancy or perinatal outcomes. No new relevant information regarding the accuracy of screening for lead toxicity was identified during the update, and we did not identify evidence that demonstrates that universal screening for blood lead results in better clinical outcomes than targeted screening. Substantial new relevant information regarding the adverse effects of screening and interventions was not identified.

CONCLUSIONS. There is no persuasive evidence that screening for elevated lead levels in asymptomatic children will improve clinical outcomes. For those children who are screened and found to have elevated levels, there is conflicting evidence demonstrating the clinical effectiveness of early detection and intervention.

Key Words: lead levels • children • pregnancy • screening • intervention

Abbreviations: USPSTF—US Preventive Services Task Force • BLL—blood lead level • AHRQ—Agency for Healthcare Research and Quality • EPC—Oregon Evidence-Based Practice Center • KQ—key question • CDC—Centers for Disease Control and Prevention • CI—confidence limit • TLC—Treatment of Lead-Exposed Children • RCT—randomized, controlled trial • DMSA—meso-2,3-dimercaptosuccinic acid • SES—socioeconomic status • GM—geometric mean • FTII—Fagan Test of Infant Intelligence • RBC—red blood cell • HUD—US Department of Housing and Urban Development

Accepted Aug 8, 2006.


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Screening for Elevated Lead Levels in Children
Journal Watch Pediatrics and Adolescent Medicine, February 7, 2007; 2007(207): 1 - 1.
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