Original articles

Developing evidence-based guidelines for referral for short stature

F K Grote¹, P van Dommelen², W Oostdijk¹, S M P F de Muinck Keizer-Schrama³, P H Verkerk⁴, J M Wit¹, S van Buuren^2,5

¹ Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
² Department of Statistics, TNO Quality of life, Leiden, The Netherlands
³ Department of Paediatrics, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
⁴ Department of Child Health, TNO Quality of life, Leiden, The Netherlands
⁵ Department of Methodology & Statistics, University of Utrecht, The Netherlands

Professor S van Buuren, Department of Statistics, TNO Quality of Life, PO Box 2215, 2301 CE Leiden, The Netherlands; Stef.vanBuuren{at}tno.nl

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.

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