Lipid Screening in Kids -- Who's Doing It?

William T. Basco, Jr., MD, MS

June 11, 2014

Implementation of Lipid Screening Guidelines in Children by Primary Pediatric Providers

Dixon DN, Kornblum AP, Steffen LM, Zhou X, Steinberger J

J Pediatr. 2014;164;572-576

Study Summary

Before 2011, guidelines to screen children for lipid disorders or hyperlipidemia focused on identifying "high-risk" children on the basis of family history. However, those guidelines were revised in 2011 to promote universal lipid screening of children aged 9-11 years.^[1] Part of the reason for the recommendation was that screening on the basis of family history may miss as many as one half of all children with elevated lipid levels.

This study was a survey of medical providers in Minnesota, and it sought to assess clinician awareness of the 2011 pediatric lipid screening guidelines. Responses were obtained from 548 clinicians (a 39% response rate), who were surveyed from December 2012 through February 2013. Respondents included pediatricians (36.7%), family medicine physicians (37%), general practitioners (11%), nurse practitioners (5.5%), physician assistants (1.6%), and pediatric subspecialists (5.3%). Only 16% of the respondents worked in a university or academic setting.

Overall, 16% of respondents performed universal lipid screening, 50% screened on the basis of either family history or patient risk factors, and 34% performed no lipid screening in children. Approximately two thirds of the respondents were unfamiliar with normative values for pediatric lipid laboratory studies. Reimbursement concerns were not considered to be barriers to lipid screening; instead, respondents identified unfamiliarity with the guidelines (31%) and discomfort addressing lipid disorders (42%) as the most prevalent barriers to providing universal lipid screening.

The study investigators concluded that education of providers is needed to move toward universal pediatric lipid screening.

Viewpoint

In their discussion, Dixon and colleagues lament that the prevalence of universal screening in this study did not vary significantly from that found in studies from 1988 and 1995. On the positive side, they identify several leverage points that could improve practice.

First, the 2011 guidelines need to be reintroduced to pediatric practitioners; this could be a role taken by professional societies. They also identify specific problems that individual practices might address, such as moving to universal screening at age 9-11 years (regardless of family history) and obtaining nonfasting, non-high-density lipoprotein (HDL) cholesterol as the first screening test. This would involve obtaining a cholesterol panel and subtracting the HDL cholesterol level, with a goal non-HDL cholesterol level < 145 mg/dL. Screening is recommended for younger children with a positive family history of an early cardiovascular event or if the child is obese or hypertensive.

Helping providers become more comfortable with addressing any abnormal laboratory values is a more involved prospect, but it certainly seems that such counseling could be worked into other efforts that a practice is undertaking to address obesity. In fact, improving lipid screening in a given practice strikes me as a very good "maintenance of certification" effort -- so who's interested?