P3.E100: Impact of changing screening guidelines on cholesterol screening in Children and Adolescents (2004-2019)

Background: In 2011, the Expert Panel of the National Heart, Lung, and Blood Institute (NHLBI) endorsed the universal screening of total and HDL cholesterol amongst the children (aged 9 to 11 years) and adolescents (aged 17 to 21 years). This study aims to evaluate the annual prevalence of cholesterol screening practices before and after the 2011 Expert Panel recommendation changes.

Methods: This retrospective study involved the review of data in electronic health records of children (aged 9 to 11 years) and adolescents (aged 17 to 21 years) who had at least one well childcare visit to the Metro Health System, Cleveland, Ohio, USA during the year reported. The study used Epic’s Slicer-Dicer tool to evaluate children and adolescents who underwent screening of total and HDL cholesterol between January 2004 and December 2019. Data collected included age, gender, and presence of obesity. For analysis, data was divided into two groups i.e., 2004-2011 and 2012-2019 and thus, the trend in cholesterol screening was assessed.

Results: Between 2004 and 2019, the percentage of children who had a well childcare visit during the reporting year and who were screened for cholesterol increased from 3.29% to 9.81% indicating a positive but suboptimal trend. Higher percentage of females (4.25% in 2004 to 10.50% in 2019) were screened compared to males (2.51% in 2004 to 9.13% in 2019). Children with at least one ICD encounter diagnosis code for obesity had 3-6 times higher cholesterol screening rates throughout the 15-year period than the overall population, but the gap decreased significantly over the 15 years (Figure 1). Comparing the age groups 9 to 11 years and 17 to 21 years, the screening among the 17- to 21-year-olds was always higher till 2015. Subsequently the percentage of children screened in both the groups have been similar (Figure 2).

Conclusion: The introduction of the Expert Panel cholesterol guideline resulted in an increase in the cholesterol screening, however, there is still a long way forward. The guidelines had a larger relative impact in increasing total screening compared to obese children and adolescents, but a larger absolute impact on increasing screening in obese children and adolescents compared to the whole population. Overall, the major of all pediatric patients eligible for screening still were not screened. This could be due to lack of awareness and motivation amongst pediatric providers. Efforts should focus on improving compliance with cholesterol screening guidelines among pediatric providers.