CALIPER: individualized-growth curves for the monitoring of children's growth.
Monitoring children's growth is a fundamental part of pediatric care. Deviation from the expected growth pattern can be an important sign of disease and often results in parental anxiety. Most preprinted growth curves are based on cross-sectional data derived from population-based studies of normal children. Since the age of the pubertal growth spurt varies substantially among the normal curves, these curves don't adequately reflect the expected growth pattern of an individual child. In addition, any preprinted growth curve based on the general population becomes less useful when the maturation of a child and the heights of it's parents differ substantially from the average. Established methods exist to adjust the general reference-growth curves for parental height. However, these methods generally are too time consuming to be used in clinic. Only heuristic methods are known to us to adjust the general-reference curves for maturation. We have developed the decision-support system CALIPER, that enables and standardizes the generation of individualized reference-growth curves. CALIPER consists of a graphical interface for data entry, a progress-report generator, and a module for the interactive, dynamic display of general-reference curves and individualized-reference curves. Preference settings such as ethnic background and gender determine the required population curves and individualization method. Individualization can be based on parental height and/or maturation. Maturation is based on an assessment of a child's bone age and/or pubertal stage. The bone age can be assessed by different methods. We have performed an evaluation of CALIPER's methodology by assessing the effect of individualization on the reference growth curves for 466 normally growing children. The individualized-reference curves reflect the growth pattern of children significantly better than the general-reference curves. CALIPER can be used on a case by case base as an aid in clinic (assessment of children's growth and communication with patient and parents) or as a tool to investigate current clinical questions concerning the relation of bone age, pubertal stage, and growth pattern for any part of the population. Besides providing for decision support by the interactive graphical representation of individualized-reference curves and growth data, CALIPER will be linked to a module that can provide automatic interpretation of the data (Kuilboer et al, SCAMC-93). CALIPER runs on a Macintosh, and requires 600K of memory. A color monitor is preferable, but not required. We will demonstrate several cases that will illustrate the clinical problem and CALIPER's potential.
Kuilboer
M M
MM
Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
Wilson
D M
DM
Musen
M A
MA
Wit
J M
JM
D001827:Body Height; D002648:Child; D005260:Female; D006128:Growth; D006801:Humans; D008297:Male; D012016:Reference Values; D012984:Software