Referral patterns of children with poor growth in primary health care.
BACKGROUND
To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these guidelines, comparing it with cut-off values mentioned by the WHO.


METHODS
Three sets of referral rules were tested on the growth data of a random sample (n = 400) of all children born between 01-01-1985 and 31-12-1988, attending school doctors between 1998 and 2000 in Leiden and Alphen aan den Rijn (the Netherlands): the screening criteria mentioned in the Dutch Consensus Guideline (DCG), those of the UK Consensus Guideline (UKCG) and the cut-off values mentioned in the WHO Global Database on Child growth and Malnutrition.


RESULTS
Application of the DCG would lead to the referral of too many children (almost 80%). The largest part of the referrals is due to the deflection of height, followed by distance to target height and takes primarily place during the first 3 years. The deflection away from the parental height would also lead to too many referrals. In contrast, the UKCG only leads to 0.3% referrals and the WHO-criteria to approximately 10%.


CONCLUSIONS
The current Dutch consensus guideline leads to too many referrals, mainly due to the deflection of length during the first 3 years of life. The UKCG leads to far less referrals, but may be relatively insensitive to detect clinically relevant growth disorders like Turner syndrome. New guidelines for growth monitoring are needed, which combine a low percentage of false positive results with a good sensitivity.
Grote
Floor K
FK
Dept. of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands. f.k.grote@lumc.nl
Oostdijk
Wilma
W
De Muinck Keizer-Schrama
Sabine M P F
SM
Dekker
Friedo W
FW
van Dommelen
Paula
P
van Buuren
Stef
S
Lodder-van der Kooij
Adry M
AM
Verkerk
Paul H
PH
Wit
Jan Maarten
JM
D001827:Body Height; D002648:Child; D002657:Child Development / Q000502:physiology*; D002662:Child Health Services / Q000592:standards*; D042241:Early Diagnosis; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D012572:School Health Services / Q000592:standards*; D006113:United Kingdom