Zawacki Amy W, Enright Connor, Harris Rachel E, Dodge Ann, Peterson Amy L
Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
J Pediatr X. 2020 Jun 13;4:100037. doi: 10.1016/j.ympdx.2020.100037. eCollection 2020 Fall.
To measure case detection and response time of severe pediatric dyslipidemia, defined as non-high-density lipoprotein cholesterol (HDL-C) ≥190 mg/dL on the initial screening panel. Although low adherence to guidelines recommending universal pediatric lipid screening is well-documented, it is unknown how clinicians respond to pediatric lipid screening results suggestive of severe dyslipidemia.
This study is a single-institution, retrospective review of patients 0-18 years of age with initial lipid panels completed from January 1, 2010, to June 30, 2018. A chart review was conducted on all patients with non-HDL-C ≥190 mg/dL to determine indication(s) for the initial lipid panel, specialty of ordering clinician, type of action taken to an abnormal result (repeat laboratory tests, treatment, and/or referral), time from result to clinician action, and diagnosis.
There were 16 860 initial lipid panels that met the inclusion criteria; 178 (1.1%) had non-HDL-C ≥190 mg/dL, indicating severe dyslipidemia. The most common indication for screening was universal screening (52%). For all lipid panels with non-HDL ≥190 mg/dL, a clinician action was documented for 47% within 7 days and 69% within 30 days. No follow-up action was documented in 18 (9%). A clinical diagnosis of familial hypercholesterolemia was the most common diagnosis, in 24% of patients.
The majority of lipid panels with non-HDL-C ≥190 mg/dL had some action documented, although the actions varied. Universal screening was the most common indication for testing, clarifying its significance in identifying severe dyslipidemia. Further education and improved management protocols may help responses to severe dyslipidemia in children at high risk for premature cardiovascular disease.
测量严重儿童血脂异常的病例检出率及反应时间，严重儿童血脂异常定义为初次筛查时非高密度脂蛋白胆固醇（HDL-C）≥190mg/dL。尽管有充分记录表明对推荐进行普遍儿童血脂筛查的指南依从性较低，但尚不清楚临床医生如何应对提示严重血脂异常的儿童血脂筛查结果。
本研究是一项单机构回顾性研究，对2010年1月1日至2018年6月30日完成初次血脂检测的0至18岁患者进行分析。对所有非HDL-C≥190mg/dL的患者进行病历审查，以确定初次血脂检测的指征、开单临床医生的专业、针对异常结果采取的行动类型（重复实验室检测、治疗和/或转诊）、从结果到临床医生采取行动的时间以及诊断情况。
共有16860份初次血脂检测符合纳入标准；其中178份（1.1%）非HDL-C≥190mg/dL，提示严重血脂异常。最常见的筛查指征是普遍筛查（52%）。对于所有非HDL≥190mg/dL的血脂检测，47%在7天内有临床医生采取行动的记录，69%在30天内有记录。18份（9%）没有后续行动记录。家族性高胆固醇血症是最常见的临床诊断，占患者的24%。
大多数非HDL-C≥190mg/dL的血脂检测有某种行动记录，尽管行动各不相同。普遍筛查是最常见的检测指征，明确了其在识别严重血脂异常中的意义。进一步的教育和改进管理方案可能有助于应对有过早发生心血管疾病高风险儿童的严重血脂异常情况。
