OBJECTIVES

Lead is a potent neurotoxin, with young children especially vulnerable to its toxic effects. In 2012, the CDC Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) issued recommendations for primary prevention. Even low levels of lead exposure can cause lifelong health and behavioral problems, so ACCLPP recommends confirmatory re-testing of children with elevated blood lead (BPb) test results (≥5 μg/dL) within 3 months, with higher BPb needing quicker action. We used linked claims and laboratory test results to assess provider adherence to these testing guidelines.

METHODS

We accessed data from the IBM MarketScan Laboratory database for individuals with employer-sponsored insurance. We identified children age <72 months who had a BPb test result of 0-200 μg/dL from 1/1/2013 – 6/30/2017 and were continuously enrolled for 179 days after the test using BPb test LOINC codes (5671-3, 77307-7, and 10368-9). We dichotomized results into “elevated” (5-200 μg/dL) and “not-elevated” (0-4.9 μg/dL). We searched the database for subsequent BPb tests within 89 and 179 days of the initial test.

RESULTS

24,652 insured children age <72 months were tested during this period, of whom 235 (<1%) had an elevated initial test result and were continuously enrolled for 179 days after that test. 79/235 children (34%) had a second test within 89 days (median time-to-second test: 32 days), while 36/235 (73%) children had a second test between 90-179 days (median: 121 days). The remaining 120/235 children (51%) were not re-tested, including 31 children with BPb ≥10 μg/dL. Among children re-tested (n=115), 48 (41.7%) had a second elevated test.

CONCLUSIONS

Prompt confirmatory testing of children with elevated BPb is important to determine the appropriate course of action. Children not re-tested may miss opportunities for secondary prevention through nutritional assessments and reduction of environmental lead hazards.