Developing evidence-based guidelines for referral for short stature
article
Objective: To establish evidence based guidelines for growth monitoring on a population basis. Study design: Several auxological referral criteria were formulated and applied to longitudinal growth data from four different patient groups, as well as three samples from the general population. Results: Almost 30% of pathology can be detected by height standard deviation score (HSDS) below -3 or at least two observations of HSDS below -2.5 at a low false-positive rate (<1%) in 0-3-year-old infants. For 3-10-year olds, a rule concerning distance to target height of >2 SD in combination with HSDS <-2.0 has the best predictive value. In combination with a rule on severe short stature (<-2.5 SDS) and a minor contribution from a rule on "height deflection", 85.7% of children with Turner syndrome and 76.5% of children who are short because of various disorders are detected at a false-positive rate of 1.5-2%.Conclusions: The proposed guidelines for growth monitoring show high sensitivity at an acceptably low false-positive rate in 3-10-year-old children. Distance to target height is the most important criterion. Below the age of 3 years, the sensitivity is considerably lower. The resulting algorithm appears to be suitable for industrialised countries, but requires further testing in other populations.
Topics
AlgorithmCeliac diseaseCystic fibrosisDiagnostic accuracyDiagnostic valueEvidence based practiceFalse positive resultIndustrializationMajor clinical studyMonitoringObservational studyPathologyPatient referralPopulationPractice guidelinePriority journalSampleScoring systemShort statureTurner syndromeClinical trialMethodologyMulticenter studypreschool childBody HeightChildChild DevelopmentChild, PreschoolFemaleGrowth DisordersHumansInfantInfant, NewbornMaleMass ScreeningNetherlandsPractice Guidelines as TopicSensitivity and SpecificitySex Factors
TNO Identifier
240686
ISSN
00039888
Source
Archives of Disease in Childhood, 93(3), pp. 212-217.
Pages
212-217
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