Foster Kids’ Standard Screenings Tests May Be of Low Value

Routine laboratory screening for children entering foster care may be costly given the low diagnostic yield, according to a study published in the December issue of Pediatrics. The authors suggest that targeted, rather than routine, laboratory screening may be a more clinically meaningful approach to manage children entering foster care.

It is estimated that more than 400,000 children are in the custody of U.S. child welfare agencies. To address concerns related to "uncoordinated or discontinuous" medical care, most states mandate children receive a physical upon entering the foster care system. In 2005, the American Academy of Pediatrics issued expert opinion-based guidance in its Healthy Foster Care America report recommending certain disease screenings through laboratory testing as part of this examination.

In order to assess the utility of laboratory screenings for children entering foster care, clinical and laboratory data was examined for 1,977 children seen at a consultation foster care clinic over a three-year period in a single county in Ohio. Standard laboratory screening included testing for infectious diseases (HIV, hepatitis B and C, syphilis, and tuberculosis), and hemoglobin and lead levels.

The researchers found that over the study period 16,754 laboratory screening tests were performed, with 60 percent of children having at least 1 laboratory abnormality. The prevalence was less than 1 percent for hepatitis B, hepatitis C, syphilis, and tuberculosis. There were no cases of HIV and a positive chlamydia test occurred among 7 percent of teenagers. Just over 4 percent of kids were anemic and 2.7 percent had high lead levels. The most common screening abnormality was a negative hepatitis B surface antibody test (54 percent), which indicates an absence immunity to the hepatitis B virus.

"High-impact screening may include lead levels for children less than 6 years old, hemoglobin screens, sexually transmitted infection testing in children 12 years and older, and HBV testing if determining potential failure to seroconvert is needed," write the authors led by Mary Greiner, M.D., from Cincinnati Children's Hospital Medical Center in Ohio. "Targeted infection screening should take local prevalence rates and other clinical indications into account."

Takeaway: It may be more cost effective to conduct targeted screenings for children entering the foster care system, while keeping certain highimpact screening tests, like those for lead, anemia, and some sexually transmitted infections, as routine.