Diagnostic approach in children with short stature.
For early detection of pathological causes of growth failure proper referral criteria are needed, as well as a thorough clinical, radiological and laboratory assessment. In this minireview we first discuss the two consensus-based and one evidence-based guidelines for referral that have been published. The evidence-based guidelines result in a sensitivity of approximately 80% at a false-positive rate of 2%. Then, relevant clues from the medical history and physical examination are reviewed, and specific investigations based on clinical suspicion listed. In the absence of abnormal clinical findings, an X-ray of the hand/wrist and a laboratory screen are usually performed. Scientific evidence for the various components of laboratory screening is scarce, but accumulated experience and theoretical considerations have led to a list of investigations that may be considered until more evidence is available.
Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. w.oostdijk@lumc.nl
Wilma
W
Oostdijk
Floor K
FK
Grote
Sabine M P F
SM
de Muinck Keizer-Schrama
Jan M
JM
Wit
D001827:Body Height; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006130:Growth Disorders / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D012017:Referral and Consultation / Q000592:standards*