Developing evidence-based guidelines for referral for short stature

Objective: To establish evidence-based guidelines for growth monitoring on a population basis. Study design: 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.