title: Use of local data to enhance uptake of published recommendations: an example from the diagnostic evaluation of precocious puberty.
abstract: BACKGROUND
  It has been recommended that basal luteinising hormone (LH) levels be used as the initial test to identify cases of central precocious puberty (CPP) in children. However, in clinical practice, gonadotropin-releasing hormone (GnRH) stimulation tests are frequently still used.
  
  
  OBJECTIVE
  To assess the diagnostic utility of a single LH to identify CPP in girls, as a means to safely reduce GnRH stimulation testing rates.
  
  
  METHODS
  Retrospective analysis of patients referred for GnRH stimulation between August 2007 and December 2010, with prospective 12-month follow-up of GnRH stimulation testing rates post implementation of management algorithm.
  
  
  METHODS
  57 girls (6.2 ± 2.1 years) with early signs of puberty.
  
  
  METHODS
  Ability of basal LH to predict clinical pubertal progression, 6 months following the GnRH stimulation test.
  
  
  RESULTS
  Pubertal progression occurred in 18 patients. All patients with a basal LH level ≥ 0.3 IU/L had subsequent pubertal progression, while 39 of 41 patients with a basal LH ≤ 0.2 IU/L did not progress, resulting in 100% specificity (95% CI 92% to 100%) and 90.5% sensitivity (69.6% to 98.8%). Using the locally derived algorithm, GnRH stimulation testing was redirected to patients with pubertal progression that was discordant with basal LH data. Post intervention, there was a 75% reduction in GnRH stimulation testing without comprising the rate of diagnosis of CPP.
  
  
  CONCLUSIONS
  Our results confirm the diagnostic utility of basal LH levels in the diagnosis of CPP and demonstrate that dissemination and interpretation of local data may facilitate change in clinical practice, resulting in streamlined patient care and cost savings.
authors.affiliation: Division of Endocrinology, The Departments of Pediatrics, The Hospital for Sick Children, , Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Harrington
authors.forename: Mark R
authors.initials: MR
authors.lastname: Palmert
authors.forename: Jill
authors.initials: J
authors.lastname: Hamilton
mesh_terms: D000465:Algorithms; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011629:Puberty, Precocious / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone