Reuters Health Information: Lab screening of kids entering foster care may have low yield
Lab screening of kids entering foster care may have low yield
Last Updated: 2017-11-15
By Will Boggs MD
NEW YORK (Reuters Health) - Laboratory screening for infectious diseases in children entering foster care yields few results that are clinically meaningful, researchers report.
"Our biggest surprise was that the risk for infectious disease was quite low in this population, at least in our area of the country," Dr. Mary V. Greiner from Cincinnati Children's Hospital Medical Center, in Ohio, told Reuters Health by email. "Youth in foster care are at high risk for medical problems and come from environments where they are in contact with adults known to be at high risk for infectious disease issues like HIV and hepatitis C. We have always assumed that foster youth would be at high risk also, but that was not the case."
Healthy Foster Care America guidelines recommend routine screening for hepatitis B virus, hepatitis C virus, tuberculosis, and syphilis, as well as HIV screening for at-risk children. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend sexually transmitted infection screening for sexually active adolescents.
Dr. Greiner's team used electronic health record data from children seen at the foster care clinic to determine the prevalence of medical illness detected by routine laboratory screening and to evaluate the clinical utility and financial costs of laboratory screening. The findings were published online November 15 in Pediatrics.
The 1,977 children evaluated at the clinic had 16,754 laboratory screening tests, with 1,193 children (60%) showing at least one laboratory abnormality. In both younger (<12 years) and older (at least age 12) children, the most common abnormality was a negative result for hepatitis B surface antibody, indicating an absence of detected immunity to hepatitis B virus.
Among children younger than 12, hepatitis C virus was the most common positive laboratory result (2.3%), but on further testing, none of the patients had true infection. Among older children, 2 of 10 with positive hepatitis C virus antibody results had true infection confirmed by polymerase chain reaction.
Of the younger children, 0.39% tested positive for tuberculosis, but there were no new infections of HIV, hepatitis B, or syphilis. Very few (4.2%) had anemia, and blood levels of lead were elevated in 2.7% of those between 6 months and 6 years of age.
Of the children age 12 or older, 6.6% tested positive for chlamydia, 0.71% had positive gonorrhea test results, and three tested positive for syphilis (two were false positives). One child had hepatitis B virus infection, 1.3% tested positive for tuberculosis, and there were no positive HIV results.
Just under 6% of older children were anemic, and 6 (4.2%) of 142 girls receiving pregnancy tests had positive findings (only one of these girls was previously aware of her pregnancy).
Laboratory tests billed to Medicaid amounted to $370,214, of which $349,122 (94%) was associated with negative or normal findings.
"Certainly, more work will need to be done to replicate these findings in other areas of the country, but our work suggests that foster care status alone may not be an indicator of elevated risk for these infectious diseases," Dr. Greiner said. "Instead, clinicians should rely on other known risk factors and community prevalence rates."
"Despite this article's focus on infectious disease findings, youth in foster care continue to be high risk for other medical problems, including developmental delay and mental health concerns, and certainly warrant 'early and often' healthcare surveillance, as recommended by the American Academy of Pediatrics," she said.
Dr. Neerav Desai from Vanderbilt University, Nashville, Tennessee, who recently reviewed pediatric and adolescent issues in underserved populations, told Reuters Health by email, "When a provider receives a patient in foster care, often there are not records of immunizations, routine screens, prenatal/birth history, or even a reliable source of past medical history of the patient. To be diligent and to rule out things that the provider can address is a natural instinct for most pediatric providers."
"The main point is that routine lab testing may or may not be indicated but that clinicians should still use their own best judgment based on the population that they deal with, including the trends of these infections and conditions in their own population," he said. "A thorough history and physical will help guide them, but sometimes this historical information is not available, in which case clinicians should individualize care for the particular patient in their office."
"More studies such as this would be helpful in other areas, including rural and urban populations, before we can generalize the findings," Dr. Desai said.