Abstracts

Rationale: Pediatric epilepsy patients are at risk for low vitamin D levels. Factors potentially related to low vitamin D levels in epilepsy patients include decreased ambulation and sun exposure, as well as antiepileptic medications. Neurologists do not regularly screen for bone health in their patients on anti-epileptic medications. Our objective was to assess bone health care amongst pediatric neurologists, and to improve screening rates by developing a standardized approach and providing education.Methods: We surveyed pediatric neurologists (n=68) at our center, on bone health care in pediatric epilepsy patients using an 11 item survey, constructed a bone health treatment algorithm and developed a training intervention (Figure 1). We reviewed charts as well as electronic lab orders before (n=199) and after (n=203) implementation of our intervention to assess changes in care. Charts were reviewed for mention of bone health , Vitamin D , laboratory evidence of 25-OH-Vitamin D testing, or prescriptions for cholecalciferol and/or ergocalciferol.Results: The overall survey response rate was 53%. Among these respondents, 64% estimated that they screened for bone health <25% of the time. Only 12% of providers estimated their screening rates to be >75%, all of whom were epileptologists. Practice of appropriate supplementation dosing was tested based on a clinical scenario question, of which only 38% answered correctly prior to intervention. Chart review before the intervention demonstrated an overall screening rate of 26% (n=52/199). Following implementation of this algorithm (Figure 1), screening rates increased to 30% (n=61/203). Practitioner documentation of Vitamin D screening increased from 19% to 25% (p=0.11). Laboratory evidence of vitamin D screening in our institution did not show a significant change (from 17% pre-intervention to 16% post-intervention, p=0.52). The frequency of neurologists prescribing cholecalciferol and/or ergocalciferol for patients on AED s (pre-intervention rate 10%, post-intervention rate 16%, p = 0.03) increased. The results of a follow up survey are pending at the time of abstract submission and will be available at the poster presentation. Conclusions: Before intervention, the majority of pediatric neurologists at our center did not screen on a regular basis for bone health. A novel standardized screening and treatment algorithm intended to improve patient care is provided. Follow up chart review to evaluate effectiveness of implementation intervention showed an improvement in attention to bone health care. Despite a relatively short follow up period, we saw modest changes in care patterns. Further implementation measures are underway to increase bone health screening and care in pediatric epilepsy patients.