title: Application of the Dutch, Finnish and British Screening Guidelines in a Cohort of Children with Growth Failure.
abstract: OBJECTIVE
  To evaluate three guidelines for selecting short children for diagnostic workup in a general pediatric clinic.
  
  
  METHODS
  All patients (n = 131) aged 3.00-9.99 years who were referred for growth failure to a general pediatric clinic were evaluated for their medical history and growth and examined. All of them underwent the same standardized diagnostic workup. Retrospectively, the criteria for the diagnostic workup from three guidelines (proposed in the Netherlands, Finland and the UK) were applied, and their sensitivity was assessed. A Dutch reference sample (n = 958) was used for calculating population specificity.
  
  
  RESULTS
  In 23 patients (17.6%), a pathological cause of their growth failure was found. The sensitivity of the original Dutch, Finnish and British guidelines was 73.9, 78.3 and 56.5% and their specificity 98.5, 83.7 and 95.8%, respectively. When adding recent growth deflection to the Dutch guideline, sensitivity increased to 87%, but specificity decreased markedly (to 87%).
  
  
  CONCLUSIONS
  The proposed cutoff values for height standard deviation score and distance to target height/mid-parental height, as used in the Netherlands and Finland, are effective for population growth monitoring, and superior to the monitoring algorithm in the UK. Growth deflection irrespective of height is an important sign of acquired growth disorders, but its specificity is too low for population screening.
authors.affiliation: Department of Pediatrics, Tergooi Hospitals, Blaricum, The Netherlands.
authors.forename: Susanne E
authors.initials: SE
authors.lastname: Stalman
authors.forename: Ilse
authors.initials: I
authors.lastname: Hellinga
authors.forename: Paula
authors.initials: P
authors.lastname: van Dommelen
authors.forename: Raoul C M
authors.initials: RC
authors.lastname: Hennekam
authors.forename: Antti
authors.initials: A
authors.lastname: Saari
authors.forename: Ulla
authors.initials: U
authors.lastname: Sankilampi
authors.forename: Leo
authors.initials: L
authors.lastname: Dunkel
authors.forename: Jan M
authors.initials: JM
authors.lastname: Wit
authors.forename: Gerdine A
authors.initials: GA
authors.lastname: Kamp
authors.forename: Frans B
authors.initials: FB
authors.lastname: Plötz
mesh_terms: D001827:Body Height / Q000502:physiology*; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005183:Failure to Thrive / Q000175:diagnosis*; D005260:Female; D005387:Finland; D006130:Growth Disorders / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D006113:United Kingdom