title: Medically underserved girls receive less evaluation for short stature.
abstract: OBJECTIVE
  To determine if gender is associated with diagnostic evaluation by primary care pediatricians caring for children with growth-faltering.
  
  
  METHODS
  This was a retrospective study of children who were attending 4 urban pediatric primary care practices affiliated with a tertiary pediatric hospital. Growth-faltering was defined as height at the <5th percentile or a z-score decrease of ≥ 1.5 SDs before 18 months of age or ≥ 1 SD thereafter. For each child, height z score, age, gender, race, insurance, diagnostic tests, and subspecialist appointments were examined.
  
  
  RESULTS
  Of 33 476 children, 3007 had growth-faltering (mean height: -1.5 ± 1.0 vs 0.3 ± 0.9 SDs in those without growth-faltering). Boys comprised 53% of the growth-faltering group (vs 51% of the nonfaltering group; P < .01). Among children with growth-faltering, 2.8% had endocrinology appointments (vs 0.8% of others; P < .0001) and 6% had gastroenterology appointments (vs 1.5% of others; P < .0001). Subspecialty care was not associated with gender. Pediatricians ordered diagnostic tests for a significantly greater proportion of children with growth-faltering than others. In multivariate analysis of height z score among children with growth-faltering, tests for chromosomes (1.4% of short girls vs 0.4% of short boys; P < .005) and growth hormone/insulin-like growth factor axis (0.9% of short girls vs 1.8% of short boys; P < .05) were associated with gender. Thirty-five percent of the girls for whom chromosome testing was performed were 12 years old or older.
  
  
  CONCLUSIONS
  Patterns in diagnostic testing of children with growth-faltering by their pediatricians may lead to underdiagnosis of Turner syndrome and growth hormone deficiency among girls.
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. grimberg@email.chop.edu
authors.forename: Adda
authors.initials: A
authors.lastname: Grimberg
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Feemster
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.forename: Mark
authors.initials: M
authors.lastname: Ramos
authors.forename: Robert
authors.initials: R
authors.lastname: Grundmeier
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cucchiara
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Stallings
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D004392:Dwarfism / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005820:Genetic Testing / Q000706:statistics & numerical data*; D057238:Growth Charts; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D010044:Outpatient Clinics, Hospital; D015143:Philadelphia; D011203:Poverty / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013002:Somatomedins / Q000032:analysis; D013960:Thyroid Function Tests / Q000706:statistics & numerical data; D014424:Turner Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D013002:Somatomedins; D019382:Human Growth Hormone