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Towards evidence based referral criteria for growth monitoring
  1. S van Buuren1,
  2. P van Dommelen1,
  3. G R J Zandwijken2,
  4. F K Grote3,
  5. J M Wit3,
  6. P H Verkerk4
  1. 1Dept of Statistics, TNO Prevention and Health, Leiden, Netherlands
  2. 2Dutch Growth Foundation, Rotterdam, Netherlands
  3. 3Dept of Paediatrics, Leiden University Medical Center, Leiden, Netherlands
  4. 4Dept of Child Health, TNO Prevention and Health, Leiden, Netherlands
  1. Correspondence to:
    Dr S van Buuren
    TNO Prevention and Health, PO Box 2215, 2301 CE Leiden, Netherlands;


Aims: To evaluate the performance of growth monitoring in detecting diseases. Turner’s syndrome (TS) is taken as the target disease.

Methods: Case-control simulation study. Three archetypal screening rules are applied to longitudinal growth data comparing a group with TS versus a reference group from birth to the age of 10 years. Main outcome measures were sensitivity, specificity, and median referral age.

Results: Clear differences in performance of the rules were found. The best rule takes parental height into account. Combining rules could improve diagnostic accuracy.

Conclusion: Growth monitoring is useful to screen for TS. A combined rule that takes absolute height SDS, parental height, and deflection in height velocity into account is the best way to do this. Similar research is needed for other diseases, populations, and ages, and the results should be synthesised into evidence based referral criteria.

  • Turner syndrome
  • guidelines
  • human growth
  • screening
  • GH, growth hormone
  • HSDS, height standard deviation score
  • TH, target height
  • TS, Turner’s syndrome
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