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Screening Strategies for Lead Poisoning

Daniel S. Blumenthal, MD, MPH
JAMA. 1993;270(21):2556. doi:10.1001/jama.1993.03510210041015.
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To the Editor.  —Gellert et al1 declare that "pediatric lead poisoning is not a major problem affecting Orange County children" because only 7.25% of a sample of 5115 such children (aged 12 to 72 months) had blood lead levels of 0.50 μmol/L (10 μg/dL) or higher, and only 0.12% had blood lead levels higher than 1.20 μmol/L (25 μg/dL). They then suggest that in Orange County and other locales with such low prevalence rates universal screening for lead could be replaced by testing only those children with a history of lead exposure or a history of risk factors for lead poisoning. Gellert et al present no information on the percentage of children with elevated blood lead levels in their sample that would have been identified by such a history; experience and older literature2 suggest that history is a poor predictor of children with elevated blood lead levels. In


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