New study examines value of routine laboratory screenings for children entering foster care

November 15, 2017, Cincinnati Children's Hospital Medical Center

Routine laboratory screening recommended for children entering foster care carries high costs and questionable medical benefits.

A new study, published online in Pediatrics, suggests that targeted screening may be a more clinically meaningful approach and reduce .

"In the context of high-value, cost-conscious care, evaluating medical practice is important and necessary," says Mary Greiner, MD, a physician at Cincinnati Children's and lead author of the study. "Targeted screening should take local prevalence rates and other clinical implications into account."

The researchers studied data between 2012 and 2015 from the medical records of nearly 2,000 and young adults less than 21 years old. These individuals were in the legal custody of Jobs and Family Services, the child protective agency of Hamilton County, Ohio, and seen at the Cincinnati Children's clinic. The clinic evaluates children in the region when they enter foster care and at every change in placement.

Clinic visits include a medical record review, physical examination and laboratory screening to test for hepatitis B and C, syphilis, tuberculosis and HIV. Clinicians obtain hemoglobin concentrations for all children and measure lead levels in children 6 months to 6 years. They screen those 12 and older who were sexually active for gonorrhea and chlamydia.

Nearly five percent of those screened were identified to have anemia, 2.9 percent infectious disease, and 2.6 percent had elevated lead levels. Seven percent of teens tested positive for chlamydia. The prevalence for hepatitis B and C, syphilis and tuberculosis was less than 1 percent. There were no cases of HIV.

"Routine screening is generally accepted when screening tools are sensitive and specific and early detection improves outcomes," says Dr. Greiner. "But costs must be reasonable in relation to anticipated benefits."

Dr. Greiner identified costs for each screening test using published Medicaid reimbursement rates. She found, for example, that the cost of screening for chlamydia in the population she studied was less than the cost of failing to diagnose and treat infection. The cost of treating active cases of tuberculosis, on the other hand, would be less than the cost of for the whole population. She suggested that more targeted screening for tuberculosis in Hamilton County and similar communities may be appropriate.

Study findings suggest that routine screening for anemia, lead (in children 6 months to 6 years old), chlamydia and gonorrhea (in sexually active adolescents) in this community is useful and cost-effective. More targeted screening may be appropriate for hepatitis B and C, tuberculosis, HIV, and syphilis, she says.

"Replicating this work with other foster care populations and developing an algorithm for targeted are important areas for future research," says Dr. Greiner. Through Dr. Greiner's work on the American Academy of Pediatrics Council on Foster Care, Adoption, and Kinship Care, these findings will inform future recommendations for delivering health care to children in foster care, she says.

Explore further: Low screening rates for adolescents diagnosed with PID in the nation's emergency departments

Related Stories

Low screening rates for adolescents diagnosed with PID in the nation's emergency departments

September 22, 2017
The nation's emergency departments had low rates of complying with recommended HIV and syphilis screening for at-risk adolescents, though larger hospitals were more likely to provide such evidence-based care, according to ...

Chlamydia screening drops after change in cervical cancer screening guideline

July 11, 2017
A 2012 cervical cancer screening guideline change is associated with reduced testing for cervical cancer and chlamydia and reduced identification of chlamydia cases in young women. Screening for chlamydia, the most commonly-diagnosed ...

Electronic health record alert improves HCV screening and treatment among baby boomers

September 15, 2017
In a recent study, screening rates for hepatitis C virus (HCV) infection among baby boomers increased fivefold in the year following implementation of an electronic health record (EHR)-based prompt for primary care physicians. ...

AAP issues guidance on STI screening for teens

July 3, 2014
(HealthDay)—Guidance is provided for screening adolescents and young adults for sexually transmitted infections (STIs) in an American Association of Pediatrics (AAP) Policy Statement published online June 30 in Pediatrics.

Chlamydia screening for pregnant young women prevents newborn complications, while saving health dollars

August 26, 2015
Chlamydia screening for all pregnant women aged between16 and 25 is cost-effective and can prevent harm to babies, a University of Melbourne study has found.

Researchers outline new policies for earlier detection of autism in children

February 2, 2017
The earlier that autism is diagnosed and treated in children, the better outcomes they will experience for future relationships and careers. However, most children aren't detected and diagnosed with Autism Spectrum Disorder ...

Recommended for you

Infant colic leads to no ongoing problems, study shows

June 21, 2018
Colicky babies whose crying eases within three months have no ongoing behavioural problems according to new research by the Murdoch Children's Research Institute (MCRI).

Diagnosing and treating disorders of early sex development

June 19, 2018
Diagnosing, advising on and treating disorders of early sex development represent a huge medical challenge, both for those affected and for treating physicians. In contrast to the earlier view, DSD (Difference of Sex Development) ...

Use of alternative medicines has doubled among kids, especially teens

June 18, 2018
A new study published in JAMA Pediatrics shows that since 2003, the use of alternative medicines, such as herbal products and nutraceuticals, among children has doubled. The University of Illinois at Chicago researchers who ...

Virtual reality headsets significantly reduce children's fear of needles

June 18, 2018
The scenario is all too familiar for the majority of parents. The crying, the screaming and the tantrums as they try to coax their children into the doctor's office for routine immunizations. After all, who can't relate to ...

Both quantity and quality of sleep affect cardiovascular risk factors in adolescents

June 15, 2018
A study from a research team led by a MassGeneral Hospital for Children (MGHfC) physician finds that both the quantity and quality of sleep—the amount of time spent sleeping and the percentage of sleep that is undisturbed—in ...

Ingesting honey after swallowing button battery reduces injury and improves outcomes

June 11, 2018
A team of ear, nose, and throat (ENT) specialists has demonstrated that eating honey after swallowing a button battery has the potential to reduce serious injuries in small children. Based on findings in laboratory animals, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.