ESPE Abstracts (2019) 92 P1-369

Detection and Referral of Children with Short Stature in Serbia - the Impact of Electronic Growth Charts

Sanja Panic1, Vukovic Rade1,2, Tatjana Milenkovic1, Katarina Mitrovic1, Sladjana Todorovic1, Ivan Soldatovic3


1Mother and Child Healthcare Institute of Serbia „Dr Vukan Cupic", Belgrade, Serbia. 2School of Medicine, University of Belgrade, Belgrade, Serbia. 3Institute for Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia


Introduction: in countries with highly developed health information systems (HIS), early detection of short stature (SS) is facilitated by automated anthropometric calculations, with warning alarms and automated referrals when prespecified conditions are met (poor growth velocity etc.). In countries where available HIS resources are insufficient for implementation of complex automated systems for growth supervision, much simpler, graphical-based growth electronic charts can be implemented in order to assist physicians in detection of growth disorders just by displaying growth charts in patient electronic health records. Such electronic growth charts (EGC) were implemented in Serbia during the year 2015.

Objective: to determine if the introduction of EGC in healthcare system of Serbia resulted in changes regarding the age of referral and number of referred children, gender and aetiology of SS in patients referred to tertiary centre for endocrine evaluation of SS.

Method: data were collected from the medical records of the Department of Endocrinology of the Mother and Child Healthcare Institute of Serbia „Dr Vukan Cupic". Records of 664 children referred to our hospital were analysed – first group (n=293) consisted of all children referred during two years prior to the implementation of EGC in Serbia (Period 1 - from January 1st 2013 to December 31st 2014), and the second group (n=371) was comprised of all children referred to our centre after the EGC implementation (Period 2 - January 1st 2016. - December 31st 2017). Epidemiological data, as well as final diagnoses regarding aetiology of the SS were collected for all subjects.

Results: analyses showed that the number of patients referred for evaluation of SS increased significantly from Period 1 to Period 2 (293 to 371, P=0,002). Also, after EGC implementation, less children with normal familial, physiological variants of SS were referred for endocrine evaluation compared to Period 1 (7.8% vs. 17.1%, P<0,001), and consequently the percentage of children with pathological causes of SS such as growth hormone deficiency increased (from 37.5% to 42.3%, P<0,001). No statistically significant changes were observed regarding the gender of patients and age at the time of referral.

Conclusion: presented data indicate that in countries where e-Health resources are limited and where implementation of complex automated systems for growth supervision cannot be introduced, even simple graphic growth e-charts like EGC introduced in Serbia in 2015 can result in higher number of referrals for the evaluation of SS, while also decreasing unnecessary referrals of children with physiologic causes of SS.

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