France E K, Gitterman B A, Melinkovich P, Wright R A
Department of Community Health Services, Denver Health and Hospitals, Colo, USA.
Arch Pediatr Adolesc Med. 1996 Sep;150(9):958-63. doi: 10.1001/archpedi.1996.02170340072014.
To determine the prevalence of elevated blood lead levels and to evaluate the accuracy of a lead screening questionnaire in a western United States urban inner-city pediatric population.
A convenience sample of children between the ages of 6 months and 6 years seen for a well-child visit were enrolled. Venous blood lead levels were measured and a lead screening questionnaire was completed.
The primary care clinics of the 10 community health centers of the city and county of Denver, Colorado. Approximately 85% of children receiving services are below the 150% poverty level and 54% are insured through the state's Medicaid program.
A total of 2978 children seen for a well-child visit from February 1993 to January 1994.
The prevalence of elevated blood lead levels and the operating characteristics of both the Centers for Disease Control and Prevention lead screening questionnaire and the complete questionnaire used in Denver, using venous blood lead levels as the criterion standard.
The mean blood lead level was 0.20 mumol/L (4.19 micrograms/dL). Eighty-five children had blood lead levels of 0.48 mumol/L (10 micrograms/dL), representing 2.9% of the study group (95% confidence interval [CI], 2.3-3.5). Only 0.3% of the cohort had blood lead levels greater than 0.96 mumol/L (20 micrograms/dL). The sensitivity, specificity, and positive predictive value of the Centers for Disease Control and Prevention questionnaire was 57%, 51%, and 3%, respectively. The sensitivity, specificity, and positive predictive value of the complete questionnaire was 59.7%, 36%, and 2.6%, respectively. The marginal cost of identifying a child with a blood lead level greater than 0.96 mumol/L (20 micrograms/dL) was $4925.
Few of the low-income children in this study had blood lead levels greater than 0.48 mumol/L (10 micrograms/dL). The questionnaire did little better than chance at predicting the presence or absence of elevated blood lead levels and cannot replace a blood lead level test for childhood lead screening in this community.
确定美国西部城市中心区儿科人群中血铅水平升高的患病率，并评估一份铅筛查问卷的准确性。
纳入前来进行健康儿童检查的6个月至6岁儿童的便利样本。测量静脉血铅水平并完成一份铅筛查问卷。
科罗拉多州丹佛市县的10个社区卫生中心的初级保健诊所。接受服务的儿童中约85%低于贫困线的150%，54%通过该州的医疗补助计划参保。
1993年2月至1994年1月期间前来进行健康儿童检查的2978名儿童。
血铅水平升高的患病率，以及以静脉血铅水平作为标准对照时，疾病控制与预防中心铅筛查问卷和丹佛使用的完整问卷的操作特征。
平均血铅水平为0.20μmol/L（4.19μg/dL）。85名儿童的血铅水平为0.48μmol/L（10μg/dL），占研究组的2.9%（95%置信区间[CI]，2.3 - 3.5）。队列中仅有0.3%的儿童血铅水平高于0.96μmol/L（20μg/dL）。疾病控制与预防中心问卷的敏感性、特异性和阳性预测值分别为57%、51%和3%。完整问卷的敏感性、特异性和阳性预测值分别为59.7%、36%和2.6%。识别一名血铅水平高于0.96μmol/L（20μg/dL）儿童的边际成本为4925美元。
本研究中很少有低收入儿童的血铅水平高于0.48μmol/L（10μg/dL）。该问卷在预测血铅水平升高与否方面表现不佳，无法替代该社区儿童铅筛查中的血铅水平检测。
