Application of the Dutch, Finnish and British Screening Guidelines in a Cohort of Children with Growth Failure

Abstract

Aims: 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%). Conclusion: 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.

A Proposal for the Interpretation of Serum IGF-I Concentration as Part of Laboratory Screening in Children with Growth Failure

“…The reported prevalence of GHD in children referred for GF to a paediatric (endocrine) clinic also varies. In Dutch studies the prevalence was between 0.5-3% (24,25,26) and in other studies prevalences between 0 and 23% were reported (27,28,29,30,31,32,33,34). For this analysis we estimated the general prevalence of GHD in children referred for GF at 2%, in line with a recent publication (35), but this percentage may differ between a general and academic paediatric clinic.…”

Early Detection, Referral, Investigation, and Diagnosis of Children with Growth Disorders

“…The false-positive rate was low. Analysis of these criteria led to an algorithm for referral of children with growth disorders [28], which has recently been updated [34] (fig. 1).…”

“…Auxological referral criteria in the Dutch, Finnish and UK primary care systems were assessed against a population of short stature patients aged between 3 and 9.9 years, referred to a general paediatric clinic in the Netherlands [34]. The training of primary care nurses in measurement techniques is essential.…”

<b>Development of Growth Management Support Tool and </b><b>Structure of Information Gathering for Child Health</b>

“…There is little difference in the physical builds between children in 2000 and children today, so these data are generally used. In contrast, growth failure is difficult to define (Stalman et al, 2015), and hence, various studies have defined it differently. For example, Jonathan (2004) defined it as growth deceleration (falling across major percentiles on the growth curve).…”