Docs comb past records with new CDC lead guidelines

New guidelines from the U.S. Centers for Disease Control and Prevention that state there is no safe level of lead exposure for children likely will pose logistic and financial challenges to physicians, The Baltimore Sun reported.

The CDC found that public health efforts should focus on ensuring children are not exposed to lead in the first place. In fact, CDC cut the threshold for lead poisoning in the blood from 10 micrograms per deciliter to 5 micrograms. It's the first change in "acceptable" levels in 20 years, according to a Health Day article.

An advisory panel to the CDC urged eliminating the phrase "blood lead level of concern" from the discussion altogether. It said health issues below 10 micrograms in children extend beyond cognitive function to include cardiovascular, immunological and endocrine effects.

The panel encouraged the roles for clinicians as the following:

  • Being a reliable source of information and taking the lead in educating families about the hazards
  • Monitoring the health status of children until all recommended environmental investigations and mitigation strategies are complete
  • Reporting blood levels at 5 micrograms or above to appropriate agencies and collaborating with those agencies to provide appropriate resources for families

The new guidelines, however, will send physicians back through their records.

"Going backward can be really hard, and for doctors with paper charts, it could be near impossible," Scott Krugman, chairman of the MedStar Franklin Square Medical Center's department of pediatrics told the Baltimore Sun. "And even for those of us with electronic records, the guidance isn't clear about how far we should go back."

The issue remains, though, to what extent physicians would be required to comb through old records to find children who tested positive, but at the lower level.

CDC spokesman Jay Dempsey told FiercePracticeManagement, "CDC is still working out how to operationalize the recommendations, and this requires that we work through issues with partner agencies that are affected, including housing agencies and clinicians. We'll update our Web pages when we have more detailed information to share."

The CDC concurred with most of the advisory panel's recommendations but cited lack of funding to follow through with many of them. Indeed, the budget for the CDC's lead poisoning programs--funding for testing, monitoring and remediation of lead-contaminated homes--has been slashed from $29 million last year to $2 million this year, according to the Sun's accompanying editorial. "The only effective way to combat it is to prevent children from being exposed in the first place," the Sun editorial states.

To learn more:
- here's the Health Day article
- read the advisory committee's recommendations
- here's the CDC's response
- here's the Baltimore Sun story
- check out the Sun's editorial