The prevalence of elevated blood lead levels and the accuracy of a lead screening questionnaire in an urban pediatric population were evaluated in the primary care clinics of 10 community health centers in the city and county of Denver, CO. Of approx 3000 low-income children tested, only 0.3% had blood lead levels >20 mcg/dL The predictive value of the CDC questionnaire was 3%, little better than chance, and the cost of identifying a child with a lead level > 20 mcg/dL was approx $5000. [1]

COMMENT. The Editor, Dr Catherine D DeAngelis, notes that “when a survey questionnaire is only slightly better than chance, it’s better to take the chance and save the money for the blood tests.” The Denver Health and Hospitals chose to screen all low-income children between 12 and 30 months of age and to forgo the use of the questionnaire. Universal screening may be omitted in low-prevalence communities, according to current CDC guidelines.

A recent survey of a nationally representative sample of pediatricians found that 53% screen all their patients aged 9 to 36 months, 96% using a blood lead assay. Most of the remainder report screening of high-risk patients only [2]. In pediatric neurology practice, a blood lead level may be indicated in high-risk children who present with neurodevelopmental delay, ADHD, seizures, or signs of encephalopathy or neuropathy.