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A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Shortcomings in infant iron deficiency screening methods
Paul G Biondich1, Stephen M Downs, Aaron E Carroll
1Children's Health Services Research, Indianapolis, Indiana, USA. pbiondich@regenstrief.org
Insights
Current iron deficiency anemia screening in pediatrics faces challenges. Few infants receive follow-up testing or documented correction, highlighting the need for improved screening strategies.
Area of Science:
- Pediatric Medicine
- Hematology
- Public Health
Background:
- Iron deficiency anemia screening is standard in pediatrics.
- Current screening recommendations face challenges impacting effectiveness.
Purpose of the Study:
- Evaluate iron deficiency anemia screening approaches.
- Assess follow-up testing and resolution rates in primary care.
Main Methods:
- Retrospective cohort study of 4984 infants (9-15 months) over 10 years.
- Analyzed electronic medical records for complete blood counts.
- Calculated positive screening rates using 9 criteria, and assessed follow-up and correction rates.
Main Results:
- Positive screening rates varied widely (1.5-14.5%) across 9 criteria.
- Low follow-up testing rates: max 25% had repeat CBC within 6 months.
- Documented correction of abnormalities was low: max 11.6%.
Conclusions:
- Current iron deficiency anemia screening practices have significant shortcomings.
- Need for a standardized, specific, and cost-effective screening criterion.
- Emphasize systems-based approaches for iron deficiency screening.
Background:
Screening for iron deficiency anemia is a well-established practice in pediatrics, but numerous challenges surrounding current recommendations raise questions about the effectiveness of this strategy.
Objective:
To evaluate iron deficiency anemia screening approaches, by assessing rates of follow-up testing and resolution among patients meeting screening criteria in a primary care setting.
Methods:
A retrospective cohort study was performed. We extracted electronic medical record data on complete blood counts for infants who received primary care in our clinics in the past 10 years. We calculated rates of positive screening results with 9 different measurement criteria and determined rates of follow-up testing and of documented correction of iron deficiency among those who screened positive.
Results:
Our cohort consisted of 4984 children who were screened at 9 to 15 months of age, between 1994 and 2004. There was a wide distribution of positive detection rates (range: 1.5-14.5%) among the 9 screening criteria. Follow-up testing rates were low. No more than 25% of infants who screened positive by any criterion underwent a repeat complete blood count within 6 months. Moreover, no more than 11.6% (range: 4.4-11.6%) had documented correction of their laboratory abnormalities.
Conclusions:
Significant shortcomings exist in current iron deficiency anemia screening practices. A widely agreed-on, specific, and inexpensive screening criterion, with increased emphasis on systems-based approaches to iron deficiency screening, is needed.
