Developing an evidence-based guideline for the referral of short stature

¹ Leiden University Medical Center, Netherlands
² TNO Quality of Life, Netherlands
³ Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands

^* To whom correspondence should be addressed. E-mail: stef.vanbuuren{at}tno.nl.

Accepted 6 September 2007

	Abstract

Objective: To establish an evidence-based guideline 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 and from 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 for those with HSDS < -2.0 has the best predictive value. After adding a rule concerning severe short stature (<-2.5 SDS) and a rule on slowed growth, 85.7% of children with Turner's syndrome and 76.5% of short children due to various disorders are detected at a false-positive rate of 1.5-2%.

Conclusion: The proposed guideline for growth monitoring shows a 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 flow chart can help practitioners in industrialized countries, but requires further testing in other populations.

Keywords: body height, childhood, growth disorders, screening

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