The Effect of COVID-19 Pandemic Restrictions on Lead Screening in a Primary Care Clinic.
Andrew J Loza, Benjamin R Doolittle
PMID 34120794WHAT IT FOUND
During peak COVID-19 restrictions, lead screening volume fell to about half, older children were screened less, and more screening tests showed elevated lead.
Missed mandatory screenings increased later.
Key findings
01Monthly lead screening volume during peak restriction was about half the prior year value (RR=0.48, p=.0002), while pre-restriction and relaxed restriction volumes were not significantly different.
02The fraction of screening tests with lead ≥ 5 μg/dL increased significantly during peak restriction (p=.02), with no significant difference during relaxed restriction (p=.1).
03Active screening deficiencies among children aged 9 months to 3 years increased significantly during relaxed restriction (0.46 vs. 0.67, p<.0001), and the rate of new deficiencies rose (RR, 2.27; p=.0002).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at one clinic in Connecticut, so its screening rates, restriction timing, and lead risk may not match other places. It used retrospective medical-record labels, so children who moved practices or had tests outside the system could look like they missed screening. Confirmatory venous results were limited by small numbers and many outstanding tests, so changes in true blood lead levels are uncertain. The main outcomes were screening tests and missed screening, not confirmed lead poisoning or clinical outcomes.
The easy way to misread this
Do not conclude that COVID-19 restrictions caused increased lead poisoning. The elevated screening results were not confirmed by venous testing because many confirmatory tests were outstanding, and the study was a single-site retrospective analysis.