Schaffer S J, Kincaid M S, Endres N, Weitzman M
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York, USA.
Pediatrics. 1996 Jan;97(1):84-90.
To determine the prevalence of elevated blood lead levels among children living in a rural area and to determine the effectiveness of the Centers for Disease Control and Prevention (CDC) Lead Risk Assessment Questionnaire and additional questionnaire items in correctly identifying rural children having elevated blood lead levels.
Comparison of results of a questionnaire that is intended to identify children as being at low or high risk for lead poisoning with children's blood lead levels.
The three practice sites of the only pediatric group in a rural county of upstate New York.
A consecutive sample of 705 children ages 6 to 72 months who were seen for health supervision visits between June and September 1993.
Sixty-nine percent of the children were considered to be at high risk for lead poisoning by the CDC questionnaire. Overall, 8.4% of the children in the study had blood lead levels of 10 micrograms/dL (0.48 mumol/L) or higher, and 2.1% had blood lead levels of 15 micrograms/dL (0.72 mumol/L) or higher. No significant difference was noted between the percentages of high- and low-risk children who had elevated blood lead levels. To devise a more effective lead risk assessment tool for children in this setting, the two items from the CDC questionnaire and the two additional items that had the greatest predictive utility were combined to form a short alternative questionnaire. The alternative questionnaire thus consisted of items concerning whether the child has a sibling or playmate with lead poisoning, whether the child lives near an industry that potentially may release lead, whether the child lives in rented or owner-occupied housing, and whether the child has a parent who is a migrant farm worker. Children categorized as high risk with the alternative questionnaire were much more likely to have elevated blood lead levels than those who were categorized as low risk. The alternative questionnaire was very effective in correctly identifying children with elevated blood lead levels. Eighty-eight percent of children having blood lead levels of 10 micrograms/dL or higher and 100% of children having blood lead levels of 15 micrograms/dL or higher were classified as high risk by the questionnaire. Children classified as low risk were very unlikely to have elevated blood lead levels; 98% of low-risk children had blood lead levels of less than 10 micrograms/dL, and 100% had blood lead levels of less than 15 micrograms/dL.
These results suggest that the CDC lead risk assessment questionnaire is of limited benefit in identifying rural children with blood lead levels 10 micrograms/dL or higher or 15 micrograms/dL or higher. An alternative questionnaire, however, seems to have marked clinical utility for identifying rural children with elevated blood lead levels.
确定居住在农村地区儿童血铅水平升高的患病率，并确定疾病控制与预防中心（CDC）铅风险评估问卷及其他问卷项目在正确识别血铅水平升高的农村儿童方面的有效性。
将旨在识别儿童铅中毒低风险或高风险的问卷结果与儿童血铅水平进行比较。
纽约州北部一个农村县唯一的儿科医疗组的三个执业地点。
1993年6月至9月期间因健康监督访视而接受检查的705名年龄在6至72个月的儿童连续样本。
根据CDC问卷，69%的儿童被认为有铅中毒高风险。总体而言，研究中的儿童有8.4%血铅水平达到或高于10微克/分升（0.48微摩尔/升），2.1%血铅水平达到或高于15微克/分升（0.72微摩尔/升）。血铅水平升高的高风险和低风险儿童百分比之间未发现显著差异。为了为该环境中的儿童设计一种更有效的铅风险评估工具，将CDC问卷中的两个项目和另外两个具有最大预测效用的项目组合起来，形成一份简短的替代问卷。替代问卷因此包括关于儿童是否有患铅中毒的兄弟姐妹或玩伴、儿童是否居住在可能释放铅的工业附近、儿童是居住在出租房还是自有住房以及儿童是否有父母是流动农场工人的项目。被替代问卷归类为高风险的儿童比被归类为低风险的儿童更有可能血铅水平升高。替代问卷在正确识别血铅水平升高的儿童方面非常有效。血铅水平达到或高于10微克/分升的儿童中有88%以及血铅水平达到或高于15微克/分升的儿童中有100%被问卷归类为高风险。被归类为低风险的儿童血铅水平升高的可能性非常小；98%的低风险儿童血铅水平低于10微克/分升，100%低于15微克/分升。
这些结果表明，CDC铅风险评估问卷在识别血铅水平达到或高于10微克/分升或15微克/分升的农村儿童方面益处有限。然而，一份替代问卷似乎在识别血铅水平升高的农村儿童方面具有显著的临床效用。
