Title
The diagnostic work up of growth failure in secondary health care ; An evaluation of consensus guidelines
Author
TNO Kwaliteit van Leven
Grote, F.K.
Oostdijk, W.
de Muinck Keizer-Schrama, S.M.P.F.
van Dommelen, P.
van Buuren, S.
Dekker, F.W.
Ketel, A.G.
Moll, H.A.
Wit, J.M.
Publication year
2008
Abstract
Background: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods: Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC - Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem) between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG) is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results: Twenty four percent of children older than 3 years were inappropriately referred (NCR). Of the correctly referred children 74-88% were short corrected for parental height, 40-61% had a height SDS <-2.5 and 21% showed height deflection (Δ HSDS < -0.25/yr or Δ HSDS < -1). In none of the children a complete detailed routine diagnostic work up was performed and in more than 30% no routine laboratory examination was done at all. Pathologic causes of short stature were found in 27 children (5%). Conclusion: Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls. © 2008 Grote et al; licensee BioMed Central Ltd.
Subject
Body height
Celiac disease
Child health care
Consensus development
Controlled study
Diagnostic procedure
Growth disorder
Health care delivery
Human
Laboratory test
Major clinical study
Medical record
Morbidity
Outpatient department
Patient referral
Pediatric ward
Practice guideline
Sensitivity and specificity
Short stature
Small for date infant
Blood
Clinical practice
Diagnosis, measurement and analysis
General hospital
Infant
Pituitary dwarfism
Standard
Statistics
University hospital
Utilization review
Adolescent
Body Height
Celiac Disease
Child
Child, Preschool
Dwarfism, Pituitary
Female
Growth Disorders
Guideline Adherence
Hospitals, General
Hospitals, University
Humans
Infant
Laboratory Techniques and Procedures
Male
Netherlands
Physician's Practice Patterns
Practice Guidelines as Topic
Referral and Consultation
Retrospective Studies
Turner Syndrome
To reference this document use:
http://resolver.tudelft.nl/uuid:21a6dbb9-d527-43fb-ba31-b4e433af8a30
DOI
https://doi.org/10.1186/1471-2431-8-21
TNO identifier
240794
ISSN
1471-2431
Source
BMC Pediatrics, 8 (8)
Document type
article