Background: Referrals to pediatric endocrine clinics for short stature are common. Height velocity (HV) is an essential component of the evaluation of short stature as growth deceleration often reflects an underlying pediatric endocrine diagnosis (PED). Access to previous measurements facilitates prompt calculation of HV.
Objective and hypotheses: To determine availability of previous measurements at time of referral for short stature, to characterize PED and to determine predictors of a PED.
Method: A retrospective chart review was performed on all referrals for short stature to a single pediatric endocrinologist between January 2008 and December 2014. Standard practice following receipt of a referral for short stature included repeated requests to the referring physician for previous measurements. Data were analyzed using t-tests, chi-squared tests, and logistic regression.
Results: A total of 326 charts of patients, aged 11 months to 18 years, were reviewed and 286 (68% male) were eligible for inclusion. The mean age at referral was 9.5 years and the mean height z-score was −2.3. Previous measurements were available in 72.4%, and 44.8% were found to have a PED. Of those with a PED, 65% had growth hormone deficiency (GHD). There was a significant relation between HV<25th percentile and a PED (P<0.0001) and between height deficit (HD) (mid parental height z-score minus height z-score) and a PED (P<0.0001). Logistic regression analysis showed that a HV<25th percentile and a HD>2 standard deviations, increased the odds of a PED by a factor of 5.12 (P<0.001) and 1.39 (P<0.005), respectively.
Conclusion: HV is a significant predictor of a PED and we found GHD to be the most common PED. Our higher rate of previous measurement availability is likely due to our effective referral screening protocol. The availability of these measurements, which are essential for HV calculation, reduces delay in diagnosis and management.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology