Delay in transitions of care in children admitted for lead chelation therapy with succimer

Introduction: Lead-based paints were banned for housing since 1978, but paint deterioration continues to expose children in at least 4 million households and increase risk of permanent neurological sequelae. Lead toxicity management includes chelation therapy with succimer among other modalities. If hospital admission is warranted, delays in initiation of succimer therapy or outpatient transition may affect hospital length of stay, school days missed, and cost. 

Objectives: To identify presence of delays in transitions of care surrounding succimer therapy for lead toxicity.  

Study Design: Retrospective chart review of children admitted for succimer therapy. 

Methods: All children admitted between September 2, 2013 and September 2, 2015 for management of lead toxicity with succimer therapy were included. Electronic health records were reviewed to obtain data. Primary endpoint was incidence of delay in initiation upon hospital admission (≥ 4 hours) and delay in discharge based on difficulty obtaining succimer in outpatient setting. 

Results: Five children received succimer during the study period: 4 males (80%), mean age 36.4 months (± 7.45), and lead source was house paint in 4 patients (2 patients consumed paint chips), and an herbal remedy for one patient. One patient was admitted twice; 6 admissions were reviewed. Mean lead concentration at admission was 51 mcg/dL ± 15.2. Mean length of hospital stay was 3 days ± 1.94. Two patients (33.3%) experienced delays to administration of chelation therapy; 4 hours each. No patients experienced a delay to discharge. However, two patients (33.3%) had assistance with transition; succimer prescription faxed to outpatient pharmacy prior to discharge.

Conclusions: Delay in care occurred in 2 of the 6 admissions upon initiation of chelation therapy. Further investigation is warranted to evaluate delays in care associated with lead toxicity management.