Management of nutritional iron deficiency anemia for young children in the emergency department

Abstract

Background Guidelines for young children with nutritional iron deficiency anemia (IDA) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize management of these patients through the development and implementation of an evidence‐based algorithm using quality improvement methodology. Procedure Baseline data of the target population (n = 42; 60% male; median age 22.5 months, median hemoglobin 5.3 g/dl) identified variability across four key measures of clinical management: laboratory evaluation, therapy choice, therapy administration, and patient disposition. Literature review and consensus from pediatric hematology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From September 2020 to June 2021, we aimed to increase IDA management per the algorithm by ≥20% relative to baseline for the four key outcome measures using sequential Plan‐Do‐Study‐Act (PDSA) cycles. Process measures focusing on provider communication/documentation and balancing measures involving efficiency and therapy‐related adverse events were assessed concurrently. Results Thirty‐five patients were evaluated among four PDSA cycles and shared similar characteristics as the baseline population. Improvements of ≥20% above baseline adherence levels or 100% adherence were achieved for all outcome measure across four PDSA cycles. Adherence to recommended laboratory evaluation improved from 43 (baseline) to 71%, therapy choice from 78 to 100%, therapy administration from 50 to 83%, and disposition from 85 to 100%. ED length of stay remained stable. Conclusions Implementation of a standardized algorithm for young children with nutritional IDA in the ED increased adherence to evidence‐based patient care.

Anemia and Associated Risk Factors in Pediatric Patients

“…In the US, it is estimated that approximately 8% of toddlers have iron deficiency, with 1-2% of them ultimately progressing to IDA. 9 The prevalence of IDA in post-menarcheal adolescent females may be as high as 15.6%. 7 The most common risk factors for the development of iron deficiency in children include prematurity, nutrient-poor diet, consumption of more than 24 ounces of cow's milk per day, and chronic blood loss.…”

“…This delay in diagnosis might place patients at risk for rare but serious complications including thrombosis, stroke, congestive heart failure, and even death. 9,26 Iron deficiency has also been associated with long-lasting consequences on neurodevelopmental outcomes. Standard test scores of 11-to 14-year-olds who had iron deficiency as infants demonstrate poorer performance on 6 different tests, including Full-Scale IQ and Wide Range Achievement Test Arithmetic and Reading.…”