Performance of several decision support tools for determining the need for systematic screening of childhood lead poisoning around industrial sites.
BACKGROUND
Living around industrial sites may expose young children to lead and cause elevated blood lead levels (BLLs). Systematic screening for childhood lead poisoning is necessarily invasive but may be appropriate, depending on children's exposure levels. Our objective was to assess the performance of several decision support tools for determining the need for systematic BLL screening in children around industrial sites.


METHODS
We used several exposure models to predict BLLs: the pharmacokinetic model IEUBK, the InVS dose model, and an empirical relation (Lewin, 1999) between soil concentrations and BLLs. We tested the BLLs (percentage of children with a BLL >100 micro g/l) that they predicted as well as threshold levels of soil pollution (200, 400, 500 ppm) for 71 situations for which the literature reports both environmental soil concentrations and BLLs in children aged 0-6 years. The tools' performance (sensitivity and specificity) was assessed by the rate of 'correct' (mass screening or not) decisions, judged retrospectively on the basis of measured BLLs, for different tolerated percentages of children with elevated BLLs.


RESULTS
Decision support systems based on soil pollution levels were not adequately protective. The IEUBK and (updated) InVS mechanistic exposure models were the most effective in this setting.


CONCLUSIONS
Exposure models may provide decision support if sufficient data about environmental contamination and dietary intake are available. Absolute performance measurement nonetheless remains difficult, in view of the limitations of the input data.
Glorennec
Philippe
P
Ecole Nationale de la Santé Publique, Rennes France. philippe.glorennec@ensp.fr
Declercq
Christophe
C
D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004781:Environmental Exposure; D005060:Europe / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007221:Industry; D007223:Infant; D007231:Infant, Newborn; D007854:Lead / Q000097:blood / Q000493:pharmacokinetics; D020264:Lead Poisoning, Nervous System, Childhood / Q000453:epidemiology*; D008403:Mass Screening / Q000379:methods*; D009656:North America / Q000453:epidemiology; D011237:Predictive Value of Tests; D011634:Public Health / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D012989:Soil Pollutants
D012989:Soil Pollutants; D007854:Lead