| Titre : | The Predictive Value of Self-Report Questions in a Clinical Decision Rule for Pediatric Lead Poisoning Screening. (2012) |
| Auteurs : | Stan-A KAPLOWITZ ; BAUM (Carl-R) : USA. Yale University. Department of Pediatrics. New Haven. CT. ; Gail D'ONOFRIO ; Barbara-M KIRRANE ; Edward-R MELNICK ; Harry PERLSTADT ; Lori-A POST ; Michigan State University. Department of Sociology. East Lansing. MI. USA ; Yale University. Department of Emergency Medicine. New Haven. CT. USA |
| Type de document : | Article |
| Dans : | Public health reports (vol. 127, n° 4, 2012) |
| Pagination : | 375-382 |
| Langues: | Anglais |
| Mots-clés : | Saturnisme ; Valeur prédictive ; Autoévaluation ; Recommandation ; Enfant ; Pédiatrie ; Exposition ; Plomb ; Intoxication ; Dépistage ; Homme |
| Résumé : | [BDSP. Notice produite par INIST-CNRS R0x88kJ8. Diffusion soumise à autorisation]. Objective. We derived a clinical decision rule for determining which young children need testing for lead poisoning. We developed an equation that combines lead exposure self-report questions with the child's census-block housing and socioeconomic characteristics, personal demographic characteristics, and Medicaid status. This equation better predicts elevated blood lead level (EBLL) than one using ZIP code and Medicaid status. Methods. A survey regarding potential lead exposure was administered from October 2001 to January 2003 to Michigan parents at pediatric clinics (n=3,396). These self-report survey data were linked to a statewide clinical registry of blood lead level (BLL) tests. Sensitivity and specificity were calculated and then used to estimate the cost-effectiveness of the equation. Results. The census-block group prediction equation explained 18.1% of the variance in BLLs. Replacing block group characteristics with the self-report questions and dichotomized ZIP code risk explained only 12.6% of the variance. Adding three self-report questions to the census-block group model increased the variance explained to 19.9% and increased specificity with no loss in sensitivity in detecting EBLLs of>=10 micrograms per deciliter. Conclusions. Relying solely on self-reports of lead exposure predicted BLL less effectively than the block group model. However, adding three of 13 self-report questions to our clinical decision rule significantly improved prediction of which children require a BLL test. Using the equation as the clinical decision rule would annually eliminate more than 7,200 unnecessary tests in Michigan and save more than $220,000. |
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