Case management protocol and declining blood lead concentrations among children

INTRODUCTION: Blood lead concentrations among children aged 6 years and younger become a concern at 10 microg/dL (0.48 micromol/L) or higher. The authors' objective was to determine whether initial blood lead concentrations of 10-19 microg/dL (0.48-0.96 micromol/L) declined among children aged 3 years and younger and whether the magnitude of decline was associated with the case management protocol of the state or local childhood lead poisoning prevention program. METHODS: The authors analyzed childhood blood lead surveillance data from 1994 through 1995 and case management protocols from six states that reported the results of all blood lead tests. The study included 2109 children aged 2 years or younger who had a venous blood lead concentration of 10-19 microg/dL (0.48-0.96 micromol/L) and a follow-up venous blood lead test within 3 to 12 months. RESULTS: Overall, blood lead concentrations increased by 0.25 microg/dL (0.01 micromol/L) between the time of the initial elevated blood lead test and the follow-up test, but concentrations declined by 1.96 microg/dL (0.09 micromol/L) among children covered by a case management protocol that included a home visit and by 0.92 microg/dL (0.04 micromol/L) among those covered by a protocol that included a lead source investigation. The decline remained significant after we adjusted for the child's age. CONCLUSION: These findings suggest that childhood lead prevention programs should consider focusing their efforts on home visits and lead source investigations