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Developing evidence-based guidelines for referral for short stature

2007; BMJ; Volume: 93; Issue: 3 Linguagem: Inglês

10.1136/adc.2007.120188

1468-2044

Floor K Grote, Paula van Dommelen, Wilma Oostdijk, Sabine M.P.F. de Muinck Keizer‐Schrama, P.H. Verkerk, Jan M. Wit, Stef van Buuren,

Prenatal Screening and Diagnostics

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.