Pettei et al write that the USPSTF Recommendation Statement is a contradictory recommendation on a nutritional deficiency of global importance. The USPSTF welcomes this opportunity to clarify the meaning of its “I statement” and explain why its recommendations may differ from those of other organizations.
The USPSTF agrees that iron deficiency anemia is a nutritional deficiency of global importance. This is why it decided to review the evidence on screening for iron deficiency anemia in young children and to issue a statement on its findings.
The USPSTF issues a statement of insufficient evidence when the current available evidence is insufficient to assess the balance of benefits and harms of a service. Evidence may be insufficient because of the limited number or size of studies, important flaws in study design or methods, inconsistency of findings across studies, findings that are not generalizable to routine US primary care practice, or a lack of information on important health outcomes. An I statement does not mean that the USPSTF recommends against providing a service. Rather, it means that the USPSTF cannot determine whether there is an overall benefit or harm to providing the service, and more information in the future may allow an estimation of effects on health outcomes. An I statement is also a call for research to close gaps in the evidence.
For this topic, the USPSTF found no studies that evaluated the direct effects of routine screening on child health outcomes such as growth, cognition, psychomotor function, or other neurodevelopmental outcomes. The studies on the benefits and harms of early treatment of iron deficiency anemia were older, had significant methodological flaws, and were conducted in settings not applicable to the current general US primary care population. Additionally, no studies evaluated an association between change in iron status (from iron deficient to iron sufficient) and improvement in child health outcomes. Although limited data from a few observational studies in young children report an association between iron deficiency anemia and learning difficulties and behavioral delays, more research is needed to determine whether routine screening for and early treatment of screen-detected, asymptomatic iron deficiency anemia in young children improves these outcomes. Thus, the USPSTF calls for more research in this area.
The USPSTF recognizes there are varying approaches and opinions about preventive health care and the process for developing recommendations for clinicians. Groups of experts may interpret evidence differently. This is most likely when the evidence is sparse or inconsistent. Other organizations may make their recommendations by using methods and processes that differ from those of the USPSTF. The USPSTF makes recommendations for individuals without symptoms of disease who receive care in US primary care settings. Other organizations may be considering different patient populations, public health perspectives, or perspectives of their members, which may result in recommendations that differ from those of the USPSTF. Some groups also choose to use expert opinion in areas where evidence is lacking or of poor quality; the USPSTF chooses to issue an I statement in such circumstances.
Conflict of Interest: None declared
- Copyright © 2016 by the American Academy of Pediatrics