Developing evidence-based guidelines for referral for short stature.
OBJECTIVE
To establish evidence-based guidelines for growth monitoring on a population basis.


METHODS
Several auxological referral criteria were formulated and applied to longitudinal growth data from four different patient groups, as well as 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 in combination with HSDS <-2.0 has the best predictive value. In combination with a rule on severe short stature (<-2.5 SDS) and a minor contribution from a rule on "height deflection", 85.7% of children with Turner syndrome and 76.5% of children who are short because of various disorders are detected at a false-positive rate of 1.5-2%.


CONCLUSIONS
The proposed guidelines for growth monitoring show 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 algorithm appears to be suitable for industrialised countries, but requires further testing in other populations.
Grote
F K
FK
Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands.
van Dommelen
P
P
Oostdijk
W
W
de Muinck Keizer-Schrama
S M P F
SM
Verkerk
P H
PH
Wit
J M
JM
van Buuren
S
S
D001827:Body Height; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D012737:Sex Factors