Schaffer S J, Campbell J R, Szilagyi P G, Weitzman M
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY, USA.
Arch Pediatr Adolesc Med. 1998 Feb;152(2):185-9. doi: 10.1001/archpedi.152.2.185.
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.
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.
One hundred forty-three responding pediatric residents (51% response rate).
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).
Most pediatric residents reported that they screened patients for elevated blood lead levels, either universally or selectively. Nevertheless, the screening practices of pediatric resident 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.
作为培训的一部分，儿科住院医师为幼儿提供初级保健服务，包括那些血铅水平可能升高的儿童。我们旨在：（1）根据疾病控制与预防中心及美国儿科学会的指南，确定对儿童进行血铅水平升高筛查的儿科住院医师的比例；（2）根据人口统计学和执业环境特征评估住院医师进行铅筛查的可能性；（3）比较报告自己是普遍筛查者、选择性筛查者或非筛查者的住院医师的态度。
作为美国儿科学会第28次研究员定期调查的一部分，对全国具有代表性的儿科住院医师样本进行保密的横断面调查。
143名做出回应的儿科住院医师（回复率为51%）。
75%的儿科住院医师报告对所有9至36个月大的患者进行血铅水平升高筛查，21%报告筛查部分患者，4%报告未进行筛查。在城市环境中照顾患者的儿科住院医师比在郊区或农村环境中照顾患者的儿科住院医师更有可能报告对患者进行血铅水平升高筛查（100%对73%；P<.001），东北部的儿科住院医师比该国其他地区的住院医师更有可能报告进行普遍筛查（93%对63%；P<.001）。总体而言，报告普遍筛查患者的儿科住院医师比报告选择性筛查患者的住院医师更有可能认为筛查的益处大于成本（67%对17%；P<.001）。
大多数儿科住院医师报告他们对患者进行了血铅水平升高筛查，要么是普遍筛查，要么是选择性筛查。然而，儿科住院医师的筛查做法及其对铅筛查相对益处和成本的看法在很大程度上反映了他们接受初级保健培训的所在国家地区和执业环境。
