Evidence map›Paper›PMID 31996264›Full record

ArticleBMC public health2020

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development.

Jeremy J Michel, Eileen Erinoff, Amy Y Tsou

Open access · goldAbstract read
In one paragraph

Article in BMC public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.9field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 10 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

Jeremy J MichelDepartment of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA. michelj@email.chop.edu.ORCID http://orcid.org/0000-0001-7262-630X
Eileen ErinoffECRI Institute Center for Clinical Evidence and Guidelines, Plymouth Meeting, PA, 19462, USA.
Amy Y TsouECRI Institute Center for Clinical Evidence and Guidelines, Plymouth Meeting, PA, 19462, USA.
ECRI Institute · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPediatric lead exposure in the United States (U.S.) remains a preventable public health crisis. Shareable electronic clinical decision support (CDS) could improve lead screening and management. However, discrepancies between federal, state and local recommendations could present significant challenges for implementation.

methodsWe identified publically available guidance on lead screening and management. We extracted definitions for elevated lead and recommendations for screening, follow-up, reporting, and management. We compared thresholds and level of obligation for management actions. Finally, we assessed the feasibility of development of shareable CDS.

resultsWe identified 54 guidance sources. States offered different definitions of elevated lead, and recommendations for screening, reporting, follow-up and management. Only 37 of 48 states providing guidance used the Center for Disease Control (CDC) definition for elevated lead. There were 17 distinct management actions. Guidance sources indicated an average of 5.5 management actions, but offered different criteria and levels of obligation for these actions. Despite differences, the recommendations were well-structured, actionable, and encodable, indicating shareable CDS is feasible.

conclusionCurrent variability across guidance poses challenges for clinicians. Developing shareable CDS is feasible and could improve pediatric lead screening and management. Shareable CDS would need to account for local variability in guidance.

Indexed as

Centers for Disease Control and Prevention, U.S.Child, PreschoolDecision Support Systems, ClinicalFeasibility StudiesHealthcare DisparitiesHumansInfantLead PoisoningMass ScreeningPractice Guidelines as TopicUnited StatesClinical decision supportGeographic variation in careLead poisoningLead Screening

Identifiers

PMID31996264
PMCPMC6990572
OpenAlexW3012455469

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.