Decreasing the cutoff for elevated blood lead (ebl) can decrease the screening sensitivity for EBL

Laura J. McCloskey, Frank R. Bordash, Kathy J. Ubben, James D. Landmark, Douglas F. Stickle

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Change in the definition of elevated blood lead (EBL) from greater than or equal to 10 mg/dL (cutoff A) to greater than or equal to 5 mg/dL (cutoff B) was recently endorsed in the United States. A potential effect of this change is to decrease the screening sensitivity for EBL detection. We demonstrate this effect by simulated sampling of an example patient distribution for lead. Using lead-dependent assay imprecision, simulated sampling of the patient distribution tracked individual misclassifications relative to the EBL cutoff. Decreasing the EBL cutoff from A to B reduced screening sensitivity for EBL detection in this population to less than 90%, a decrease of 4%. The result was due to the fact that, for B, a greater fraction of the EBL population was near the EBL cutoff and therefore subject to misclassification due to assay imprecision. The effect of the decreased EBL cutoff to reduce EBL screening sensitivity is likely to apply to EBL screening programs generally.

Original languageEnglish (US)
Pages (from-to)360-367
Number of pages8
JournalAmerican journal of clinical pathology
Issue number3
StatePublished - Mar 2013


  • Atomic absorption
  • Elevated blood lead
  • Lead
  • LeadCare II
  • Point-of-care testing
  • Screening
  • Simulation

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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