The predictive value of self-report questions in a clinical decision rule for pediatric lead poisoning screening.

Abstract

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.
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.
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.
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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See 1 article found by title matching your search:
Public Health Rep. 2012 Jul;127(4):375-82.
The predictive value of self-report questions
in a clinical decision rule for pediatric lead
poisoning screening.
Kaplowitz SA, Perlstadt H, D'Onofrio G, Melnick ER, Baum CR, Kirrane BM, Post LA.
Source
Michigan State University, Department of Sociology, East Lansing, MI.

Page 2

Abstract
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.
PMID:
22753980
[PubMed - in process]
PMCID:
PMC3366295
[Available on 2013/7/1]