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An audit of sickle cell screening in a paediatric hospital population
A Baraka1, G Haddock, X Roussis
1Department of Paediatric Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow.
Insights
UK sickle cell disease (SSD) screening guidelines are costly. A retrospective audit found a low incidence of SSD in a diverse patient population, suggesting selective screening may be more cost-effective for certain ethnic groups.
Area of Science:
- Hematology
- Public Health
Background:
- Current UK guidelines recommend pre-operative sickle cell disease (SSD) screening for specific ethnic groups.
- These guidelines have significant cost implications for the National Health Service (NHS).
Purpose of the Study:
- To retrospectively audit the utilization and outcomes of SSD screening in a UK institution.
- To evaluate the cost-effectiveness of current SSD screening protocols.
Main Methods:
- Retrospective audit of 1305 patients under 15 years old screened for SSD between January 1987 and August 1992.
- Analysis of patient ethnicity and screening test results.
Main Results:
- 85.8% of tests were performed on surgical patients.
- The majority of tested patients were of Asian descent (73%), with 27% of African or Afro-Caribbean descent.
- Only four patients (0.3%) tested positive for sickle cell trait; three were of Afro-Caribbean descent and one from Bahrain.
Conclusions:
- The incidence of sickle cell hemoglobin (HbS) is low in the studied population.
- Continued SSD testing for patients of African or Afro-Caribbean descent is supported.
- A selective screening policy may be appropriate for other ethnic groups to improve cost-effectiveness.
Abstract:
Current UK guidelines for the detection of sickle cell disease (SSD) recommend pre-operative screening of patients of African or Afro-Caribbean descent and of patients from the Middle East, South Italy, Greece and India. These recommendations have considerable cost implications for the NHS. We have undertaken a retrospective audit of the use of SSD screening in our own institution. Between January 1987 and August 1992, 1305 patients under 15 years of age (mean 3.8 years) underwent screening for SSD. Surgical patients accounted for 1120 tests (85.8%). The majority of patients tested were of Asian descent (n = 955; 73%); only 350 (27%) were of African or Afro-Caribbean descent. Only four patients (0.3%) tested positive (all sickle cell trait); three of Afro-Caribbean descent and one from Bahrain. We conclude that, in our population, the incidence of HbS is low. Patients of African or Afro-Caribbean descent should continue to be tested but a selective policy may be indicated in other ethnic groups.