P2.189: Adherence to Lipid Screening at a Pediatric Resident Clinic

Background: Cardiovascular disease, including hypertension, coronary artery disease, heart failure, and stroke, is the leading cause of death in the U.S., affecting nearly half of adults. Atherosclerosis begins in childhood, emphasizing the benefit of early identification and management of pediatric risk factors. Current guidelines used in our resident clinic recommend universal lipid screening for children aged 9-11 and selective screening for those aged 2-8 (childhood) and 12-16 (adolescent) with risk factors, including a family history of cardiovascular disease, elevated cholesterol, diabetes, hypertension, obesity or overweight (BMI ≥95th or ≥85th percentile, respectively), or smoking. We sought to evaluate adherence to lipid screening guidelines in our pediatric resident clinic.

Methods: The IRB-exempt study is a retrospective investigation using reporting tools from our electronic medical record (Epic’s Slicer Dicer) to collect laboratory data from 11,366 patients ( < 17 years) who attended our resident clinic from March 24, 2024, to March 24, 2025. Patients were stratified by age: 0 - < 2, 2 - < 9, 9 - < 12, and 12 - < 17 years, then subdivided by BMI percentile: < 5%, 5% - < 85%, 85% - < 95%, and ≥95%. Tests analyzed included total cholesterol, LDL, HDL, and triglycerides from hospital and commercial laboratories. Descriptive analysis assessed screening adherence and abnormal lab frequencies, stratified by age and BMI.

Results: Among universally screened 9 to < 12-year-olds, only 12.4% of expected labs were completed (Figure 1). As BMI increased within this group, both screening adherence and the rate of abnormal lab results rose. Only 4.5% of expected labs were ordered for healthy-weight children aged 9–11 years, with 30% of those yielding abnormal results (Figure 2). These findings suggest early cardiovascular risk even among healthy-weight children, indicating under-recognized metabolic issues not solely linked to BMI. In childhood selective screening, labs ordered were minimal (6.2%), leaving most at-risk children unscreened—despite 43.3% of completed labs returned abnormal. Although selective screening increased to 23.5% in adolescents, there are still considerable lab abnormalities in overweight (34%) and obese (42%) patients, reflecting missed opportunities to detect dyslipidemia. These gaps increase the risk of undiagnosed, progressive cardiometabolic disease during formative years.

Conclusion: The evaluation revealed substantial under-ordering of lipid screening labs at our resident clinic, despite existing guidelines. Given the existing high rates of abnormal results, improved adherence would likely uncover more cases of dyslipidemia in at-risk children. Future quality improvement efforts should integrate screening recommendations into age-specific well-child note templates to increase provider adherence and provide an opportunity to document family reasons for deferral. The ultimate goal is to improve adherence to screening guidelines and enable early intervention for pediatric patients.