Abstract 14052: Differences in Pediatric Cholesterol Screening Rates Between Family Medicine and Pediatrics Correlate With Conflicting Guidelines

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amy L Peterson ◽  
Ann M Dodge ◽  
Jens Eickhoff ◽  
Kathleen DeSantes ◽  
Magnolia Larson ◽  
...  
Keyword(s):  
Family Medicine ◽  
Task Force ◽  
Moving Average ◽  
Density Lipoprotein ◽  
National Guidelines ◽  
Educational Tools ◽  
Blood Institute ◽  
Cholesterol Screening ◽  
National Heart Lung ◽  
Preventative Services

Introduction: In 2011, the National Heart, Lung, and Blood Institute released pediatric cardiovascular guidelines, recommending universal cholesterol screening between ages 9-11 and 17-21 years. This guideline conflicts with other organizations, notably the 2016 United States Preventative Services Task Force (USPSTF) statement which did not endorse universal screening. Our institution has utilized educational tools and electronic health record (EHR) modifications to encourage pediatric cholesterol screening. Hypothesis: Changes in pediatric lipid screening rates within a single institution correlate with release of national guidelines, as well as local educational tools and EHR modifications. Methods: Order placement was defined as ordering a high-density lipoprotein cholesterol level in a patient 9-21 years with ≥ 1 well visit in prior 3 years. Order placement rate (OPR) was calculated per month using 3 months’ moving average smoothing and analyzed based on date and specialty of ordering clinician. Timing of educational tools, EHR modifications, and national guideline release were analyzed for changes in OPR. Results: A total of 36,756 visits from 2010-2019 with 21,239 orders were analyzed. Total OPR was 57.8%. Prior to 2011 guideline, pediatrician (P) OPR was 41% (95% CI: 36-47%) and 9% (7-10%) for family medicine (FM). OPR increased in the 12 months after 2011 guideline, educational initiatives, and EHR changes for P (80%, 95% CI: 76-83%) and FM (21%, 95% CI: 19-25%) . Both P and FM had lower rates after 2016, with greater decrease for FM (p<0.001 for all). Conclusions: OPR was higher in P than FM, with largest OPR changes correlating with release of guidelines. Larger positive changes in OPR were seen in P compared to FM after 2011 guideline, and larger decrease in OPR in FM compared to P correlating with 2016 USPSTF statement release. Conflicting guidelines may contribute to lower overall OPR as well as different screening rates for children cared for by P and FM.

Blood Pressure

PEDIATRICS ◽  
1987 ◽  
Vol 80 (3) ◽  
pp. 459-460
Author(s):  
MYUNG K. PARK
Keyword(s):  
Blood Pressure ◽  
Laboratory Testing ◽  
Normative Data ◽  
Task Force ◽  
Pressure Control ◽  
Proper Treatment ◽  
Blood Institute ◽  
National Heart Lung ◽  
Standards And Guidelines

To the Editor.— Recently the National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children published revised normal BP standards and guidelines for children.1 I welcome this effort, as reliable normative data have been unavailable but are prerequisite for the early detection of hypertension and its proper treatment. The guidelines published by the Task Force for the detection of hypertension, the diagnostic evaluation, follow-up laboratory testing, and treatment are, in my opinion, excellent.

What Should Blood Pressure Be in Healthy Children?

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 143-145
Author(s):  
Wallace W. McCrory
Keyword(s):  
Blood Pressure ◽  
Task Force ◽  
The United States ◽  
Progressive Increase ◽  
Healthy Children ◽  
The Novel ◽  
Blood Institute ◽  
Recent Commentary ◽  
National Heart Lung ◽  
Novel Concept

In a recent commentary,1 Adams and Landaw propose the novel concept that normally growing children need not have an associated progressive increase in blood pressure (BP). Noting that the National Heart, Lung and Blood Institute Task Force graphs to be used for plotting of pressure during growth and maturation show a continual increase of BP levels with age, they state that "Any implication that this is a healthy phenomenon associated with the aging process . . . is unjustified."2 To support this concept they cite data from studies in unacculturated tribes (ie, the Yanomamo Indians) showing that mean BP levels of these indians aged 0 to 50+, except for a slight increase from ages 0 to 9 years to 10 to 19 years, show no increase with age; this pattern is unlike that found in the United States and other Western cultures.

The Relationship between Chronic Rhinosinusitis and Metabolic Syndrome

2017 ◽  
Vol 31 (4) ◽  
pp. 222-227 ◽  
Author(s):  
Eun Jung Lee ◽  
Hye Jin Hwang ◽  
Chan Min Jung ◽  
Min Ki Kim ◽  
Min Seok Kang ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Allergic Rhinitis ◽  
Chronic Rhinosinusitis ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Density Lipoprotein ◽  
Heart Association ◽  
Significant Risk Factor ◽  
Blood Institute ◽  
National Heart Lung

Background This study aimed to investigate the correlation between metabolic syndrome and chronic rhinosinusitis (CRS), with related risk factors for CRS according to data from the Korean National Health and Nutrition Examination Survey (KNHANES). Methods The KNHANES surveyed individuals >19 years of age from January 2010 to December 2011. CRS encompassed “symptom-based CRS” as defined by the European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Metabolic syndrome was diagnosed according to the American Heart Association/National Heart Lung and Blood Institute criteria. A χ2 analysis, univariate analysis, and multivariate analysis were conducted. Results A total of 12,015 individuals were analyzed in this study. The prevalence of CRS in the patients with metabolic syndrome (high triglyceride level, reduced high-density lipoprotein level, and elevated blood pressure) was significantly higher than that in patients without metabolic syndrome (14.15 versus 10.16%) (p < 0.05). Allergic rhinitis was the only significant risk factor for CRS found to be associated with metabolic syndrome (p < 0.05). Conclusion CRS was more prevalent in patients with metabolic syndrome, especially those with allergic rhinitis, than in patients without metabolic syndrome. Accordingly, CRS should be considered in patients with metabolic syndrome and allergic rhinitis.

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