Discussing the importance of lipid screenings in the pediatric population

Transcription (edited for clarity):

Contemporary Pediatrics®:

Hi, thank you for joining us. I'm Joshua Fitch, editor of Contemporary Pediatrics®.

Dave Little, MD, MS:

And I'm Dave Little. I am a family physician by training, and a member of the Epic Research team here at Epic Electronic Health Record Corporation.

Contemporary Pediatrics®:

Dr. Little thank you so much for taking the time. Dr. Little is here to discuss lipid level screenings and how they can play a role in childhood obesity. First, can you explain what these lipids are and how a screening for them and children with obesity can play a role in treatment?

Little:

Sure, the lipid is the medical word for cholesterol, and I think most of us as adults are familiar with cholesterol and that it's a bad thing and it contributes to strokes and heart attacks. What folks are less aware of is that there are recommendations that our kids should also be getting screened. Our kids should all get screened between the ages of 9 and 11, and in kids that have additional risk factors, diabetes, or high blood pressure, or obesity, or a strong family history of heart disease at a young age, kids in those risk groups should get their screening sooner between the ages of 2 and 8.

Contemporary Pediatrics®:

According to your research, some of these screenings are not being done, even if a risk assessment is present for obesity, correct? Why is that the case?

Little:

The research came from the Epic Research database called Cosmos, and Cosmos is a deidentified database that brings together clinical data from hundreds of healthcare organizations that use Epic Electronic Health Record software. We make that available to support medical research and healthcare decision making. Currently, we have 190 million patients in the Cosmos database, and that was the group that that we studied in our analysis. When we looked at the kids in the at-risk group, from ages 2 to 8 that we discussed–that was about 165,000 patients we looked at–we found that only about 5 and a half percent of those were getting screened. The older kids from 9 to 11, we looked at a population of 237,000 children and found that only 18.8% of those were getting screened, so you're absolutely correct that that a lot of screenings that need to happen, are not happening. Now your question why those screenings are not happening, we don't know that from our data. But we can think about what happens in the typical office visit. It may be that providers are not aware, it may be that the patients and families are not aware. It may be that those tests don't routinely get reimbursed by the by the payers. Those are those are all possibilities. We have recommendations available. The [Centers for Disease Control and Prevention] (CDC) has put the recommendation out there. The leading pediatric organization Bright Futures has also put those recommendations out there. So, I don't think in our data we have an answer as to why those screenings are not happening. We do have ways that we can leverage the electronic health record to improve those screenings through the process that we call clinical decision support. Clinical decision support is prompts that are provided to physicians within the patient record. For example, if we have information in a patient's health record that this patient had high risk, the physician may receive a prompt, "hey, it would be a good idea to do cholesterol screening on this patient." That's the role of Epic and other health record and developers to put those things into play. The other thing that I would recommend for improving screening rates is better public health education. Parents all know that their kids need shots. It's usually the parents who are initiating "hey, when are my kids’ shots do? When can I get my next appointment for my checkup?" As the parents drive that, and as the clinical decision support is directed not only at the providers, but also the patients and importantly, the parents, then the parents will be the one to drive the providers to make sure that those screenings get done.

Contemporary Pediatrics®:

Thank you, Dr. Little. Once the screenings take place, what are the next steps for the health care providers? Even for these at-risk children? Those are the ones being screened, correct? So how, how does the treatment process begin after a screening is complete?

Little:

Once the screening is complete, depending on the severity of the cholesterol elevation, in most cases, the process will begin with some counseling for the child and their family around better diet and more activity and better exercise. In this day and age in particular, folks need to pay attention to screen time. Kids these days are spending a lot more time in front of their screens, and a lot less physically active, and a lot of that was aggravated by the pandemic when we were all kind of shut in and the habits that folks develop not just kids, but the habits that all of us developed in response to being locked in throughout the pandemic, have carried over. So, there's a lot of health behaviors that would be the first line of treatment for these young folks that have the cholesterol problem.

Contemporary Pediatrics®:

Why are these screenings essential for these at-risk children? And again, can you just touch on the direct impact that a screening is going to provide?

Little:

You know, we screened kids for cholesterol because we want kids to have a healthy life from age 2 or age 8 or age 9 or whenever they get that first screening throughout their life. The sooner that you can introduce and reinforce positive health behaviors in kids, that's going to make all the difference in the world. The sooner you can get those cholesterol levels under control, the more you're going to have an impact on that long term risk of developing premature heart attacks, premature strokes, and the other complications of high cholesterol that can be seen. So, the sooner you get on top of those things, medically, it's better and behaviorally and socially it's better as well. So, on both those fronts, the medical and the behavioral fronts, it is a great idea to get kids started on a healthy lifestyle as early on as possible.

Contemporary Pediatrics®:

Thank you, Dr. Little. Anything else you would like to add in regard to these screenings?

Little:

Thank you, first of all, that you're putting the word out, because I think awareness is kind of the gap that we have seen in our research. Let's get the word out to providers through broadcasts like this and let's work on getting the word out to the population and to parents and their kids to go get those cholesterol numbers checked. Really, the more that the patients and families drive not only the solutions but asking the questions, the better off it's going to be in the long run.

Reference:

Little D, Deckert J, Bartelt K, McNitt J. Few pediatric patients screened for high lipid levels despite expert recommendations. Epic Research. June 1, 2023. Accessed June 21, 2023. https://epicresearch.org/articles/few-pediatric-patients-screened-for-high-lipid-levels-despite-expert-recommendations