Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH.
Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH.
J Pediatr. 2023 Aug;259:113487. doi: 10.1016/j.jpeds.2023.113487. Epub 2023 May 16.
To analyze laboratory testing results from pediatric patients newly diagnosed with celiac disease to determine the usefulness of each test derived from recommended guidelines.
Serological testing at the time of diagnosis from patients enrolled in our celiac disease registry from January 2018 through December 2021 was reviewed. The incidence of abnormal laboratory results, routinely obtained as per the recommendations of Snyder et al and our institution's Celiac Care Index, was assessed. Rates of abnormal laboratory values and estimated costs associated with these screening measures were analyzed.
Our data demonstrated abnormalities in all serological testing obtained at celiac diagnosis. Hemoglobin, alanine aminotransferase, ferritin, iron, and vitamin D screening were found to be abnormal with notable frequency. Only 7% of patients had an abnormal thyroid-stimulating hormone and <0.1% had an abnormal free T4. Nonresponse to hepatitis B vaccination was prominent, with 69% of patients considered nonimmune. Screening protocols as currently outlined in our Celiac Care Index resulted in an estimated cost of approximately $320 000 during our study.
Review of screening laboratory results at our center reveals that abnormal values for several recommended measures are uncommon. Thyroid screening was infrequently abnormal and the usefulness of screening for hepatitis B at diagnosis is uncertain. Similarly, our data suggest that iron deficiency screening may be condensed effectively into hemoglobin and ferritin testing, eliminating the need for initial iron studies. Decreasing baseline screening measures could safely decrease the burden of testing on patients and overall healthcare expenditures.
分析新诊断为乳糜泻的儿科患者的实验室检测结果，以确定源自推荐指南的每项检测的实用性。
回顾了 2018 年 1 月至 2021 年 12 月期间参加我们乳糜泻登记处的患者在诊断时的血清学检测结果。评估了根据 Snyder 等人的建议和我们机构的乳糜泻护理指数常规获得的异常实验室结果的发生率。分析了异常实验室值的比率以及与这些筛查措施相关的估计成本。
我们的数据显示，在乳糜泻诊断时获得的所有血清学检测均存在异常。血红蛋白、丙氨酸氨基转移酶、铁蛋白、铁和维生素 D 筛查结果异常频率显著。仅有 7%的患者促甲状腺激素异常，<0.1%的患者游离 T4 异常。乙型肝炎疫苗接种无反应很明显，有 69%的患者被认为是非免疫的。根据我们的乳糜泻护理指数目前的规定，筛查方案在我们的研究期间估计花费约 32 万美元。
对我们中心的筛查实验室结果进行审查后发现，推荐的几项措施的异常值并不常见。甲状腺筛查异常情况罕见，且在诊断时筛查乙型肝炎的用途不确定。同样，我们的数据表明，缺铁筛查可以有效地纳入血红蛋白和铁蛋白检测，从而无需进行初始铁研究。减少基线筛查措施可以安全地减轻患者和整体医疗保健支出的检测负担。
