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Developing evidence-based guidelines for referral for short stature

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Author: Grote, F.K. · Dommelen, P. van · Oostdijk, W. · Muinck Keizer-Schrama, S.M.P.F. de · Verkerk, P.H. · Wit, J.M. · Buuren, S. van
Institution: TNO Kwaliteit van Leven
Source:Archives of Disease in Childhood, 3, 93, 212-217
Identifier: 240686
doi: doi:10.1136/adc.2007.120188
Keywords: Health · Algorithm · Celiac disease · Cystic fibrosis · Diagnostic accuracy · Diagnostic value · Evidence based practice · False positive result · Industrialization · Major clinical study · Monitoring · Observational study · Pathology · Patient referral · Population · Practice guideline · Priority journal · Sample · Scoring system · Short stature · Turner syndrome · Clinical trial · Methodology · Multicenter study · preschool child · Body Height · Child · Child Development · Child, Preschool · Female · Growth Disorders · Humans · Infant · Infant, Newborn · Male · Mass Screening · Netherlands · Practice Guidelines as Topic · Sensitivity and Specificity · Sex Factors


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.