Clinician Responses to Pediatric Lipid Screens Suggestive of Severe Dyslipidemia

Objectives

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.

Study design

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.

Results

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.

Conclusions

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.