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Screening Strategies for Elevated Blood Lead Levels

John S. Andrews, MD
Arch Pediatr Adolesc Med. 1997;151(6):636. doi:10.1001/archpedi.1997.02170430102027.
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In their article about the costs of lead screening in children, Campbell et al1 conclude that among 2 universal strategies for screening for elevated blood lead levels, obtaining fingerstick samples is less costly than obtaining venous samples. This conclusion is obvious given their assumptions that (1) fingerstick samples are cheaper to obtain than venous samples and (2) elevated blood lead level is a low-prevalence event and the specificity of fingerstick samples is high (eg, venous blood measurements are infrequently necessary to confirm elevated blood lead concentrations in fingerstick samples). Unfortunately, because no information about the benefits of detecting elevated blood lead levels or the risks of missing a case is presented, there is no way to interpret the results of the article. The authors conclude that fingerstick samples save $1.84 per patient screened. A more appropriate denominator for the presentation of their results, such as the cost per case


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