RESUMO
OBJECTIVE: To identify non-high-density lipoprotein cholesterol (HDL-C) and HDL-C thresholds for pediatric nonfasting lipid screens that are more predictive of the need for lipid-lowering pharmacotherapy and estimate numbers of potentially avoidable fasting lipid panels. STUDY DESIGN: In this retrospective review of children and youths aged 8-21 years presenting for preventive cardiology care, initial lipid results, recommendations for pharmacotherapy, and presence of additional cardiovascular risk factors were noted. Receiver operating characteristic curve analysis calculated threshold lipid values predicting the need for pharmacotherapy and were applied to 2 screening populations. Rates of potentially unnecessary fasting lipid panels were calculated. RESULTS: A non-HDL-C value >156 mg/dL for children with ≥1 cardiovascular risk factors and >199 mg/dL for children without risk factors conferred 95% or greater sensitivity in predicting a recommendation for pharmacotherapy with higher specificity, positive predictive value, and negative predictive value compared with current guidelines. HDL-C was a poor predictor of pharmacotherapy. Application of the current thresholds to screening populations indicated that 38.5%-92.3% of follow-up fasting lipid panels would not result in pharmacotherapy. CONCLUSION: Using higher non-HDL-C and lower HDL-C thresholds could prevent unnecessary follow-up lipid panels and reduce patient anxiety, cost, and time. This could improve compliance with universal pediatric lipid screening for both health care providers and families.
Assuntos
Doenças Cardiovasculares/prevenção & controle , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Hipercolesterolemia/diagnóstico , Hipolipemiantes/administração & dosagem , Lipídeos/normas , Adolescente , Fatores Etários , Doenças Cardiovasculares/etiologia , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hipercolesterolemia/complicações , Masculino , Programas de Rastreamento , Valor Preditivo dos Testes , Prevenção Primária/métodos , Padrões de Referência , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Early detection and treatment of pediatric asthma could reduce morbidity and lessen burden on society. Currently there is no known research on the prevalence of pediatric asthma in the Dominican Republic (DR) and no known asthma risk assessment tool for one-time encounters in a fast-paced clinic. OBJECTIVES: To pilot a streamlined version of previously validated screening tools to estimate the prevalence of pediatric asthma risk in Santo Domingo Norte, DR. METHODS: A combined asthma questionnaire and clinical assessment tool was developed and administered to patients aged 2-12 years. FINDINGS: We found that 25.7% of the 74 study participants were categorized as probable asthma, 21.6% were at high risk for asthma, 14.9% elevated risk, and 37.8% not at risk. CONCLUSION: If the prevalence of 25.7% is representative of the DR as a whole, the DR would have one of the highest national rates in Latin America. The study assessment tool was convenient to use, but tool validation is needed.