Importance of Assessing Wellbeing for United States Preventive Services Task Force Recommendations

* Abbreviation: USPSTF — : US Preventive Services Task Force Child health care providers spend a large portion of their time practicing preventive medicine. This includes screening, providing anticipatory guidance and counseling, and, less commonly, prescribing preventive medications.1 The US Preventive Services Task Force (USPSTF) makes recommendations on the basis of a systematic evaluation of scientific evidence that assesses the impact of clinical preventive services on child health, taking into account both the benefits and harms of preventive services.2 The USPSTF does not use expert opinion or clinical judgement when developing recommendations. Because the USPSTF follows a strict evidence-based approach, it frequently finds insufficient evidence to support preventive services.3 The USPSTF issues “I statements” when it judges the scientific evidence underlying a preventive service to be insufficient to assess the overall balance of benefits and harms. An I statement does not signify that the preventive service is or is not beneficial but, rather, that the evidence base has gaps that preclude a definitive recommendation. Of the USPSTF’s 45 recommendations relevant to children and adolescents, nearly half are I statements, including screening for speech and language delay,4 autism spectrum disorder,5 and elevated blood lead levels6 and counseling or other interventions to prevent illicit or nonmedical drug use.7 Although each I statement has a unique set of reasons for why the relevant evidence is judged to be insufficient, the most common include a lack of data for the effect of the preventive service on ultimate health outcomes, including length or quality of life, and the inability to extrapolate evidence derived from research in symptomatic populations to screen-detected populations identified in primary care. … Address correspondence to Michael Silverstein, MD, MPH, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118. E-mail: michael.silverstein{at}bmc.org