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Developing an evidence-based guideline for the referral of short stature
  1. Floor K. Grote (f.k.grote{at}
  1. Leiden University Medical Center, Netherlands
    1. Paula van Dommelen (paula.vandommelen{at}
    1. TNO Quality of Life, Netherlands
      1. Wilma Oostdijk (w.oostdijk{at}
      1. Leiden University Medical Center, Netherlands
        1. Sabine M.P.F. de Muinck Keizer-Schrama (s.demuinckkeizer-schrama{at}
        1. Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
          1. Paul H. Verkerk (paul.verkerk{at}
          1. TNO Quality of Life, Netherlands
            1. Jan M Wit (j.m.wit{at}
            1. Leiden University Medical Center, Netherlands
              1. Stef van Buuren (stef.vanbuuren{at}
              1. TNO Quality of Life, Netherlands


                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.

                • body height
                • childhood
                • growth disorders
                • screening

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