Use of Electronic Health Records for Automated Screening of Growth Disorders in Primary Care

Sankilampi, Ulla; Saari, Antti; Laine, Tiina; Miettinen, Päivi J.; Dunkel, Leo

doi:10.1001/jama.2013.218793

Cited by 48 publications

(41 citation statements)

References 4 publications

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“…First, the prevalence of pathological causes among all the children of this cohort is comparable to most previous observations in children with growth failure, reporting an incidence between 1.3 and 19.8% [3], [18,19,20,21,22,23]. In none of these studies was a complete detailed routine diagnostic workup performed.…”

Section: Discussionsupporting

confidence: 80%

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

Stalman

Hellinga

Dommelen³

et al. 2015

Horm Res Paediatr

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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.

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Section: Discussionsupporting

confidence: 80%

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

Stalman

Hellinga

Dommelen³

et al. 2015

Horm Res Paediatr

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“…The detection of abnormal growth is usually the main goal when creating reference data for use in healthcare systems worldwide [2][3][4][5][10][11][12][13][14][15]. As such, growth references have greatest utility when data variability is low, and therefore, children who are unhealthy or have known abnormalities ought to be omitted; by representing only healthy growth, the resulting instrument is sharper [10,11,14,16].…”

Section: Why Is Human Growth Pattern Of Interest?mentioning

confidence: 99%

“…For larger populations, it is not practical to obtain very regular measurements from birth to adult height, especially if children are followed in ordinary healthcare settings [10,15,16]. We have now estimated the CIs for each individual parameter, which allows the possibility of defining more objective criteria for evaluating the reliability of data.…”

Section: Principle Findingsmentioning

confidence: 99%

Modelling individual longitudinal human growth from fetal to adult life − QEPS I

Nierop

Niklasson

Holmgren

et al. 2016

Journal of Theoretical Biology

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“…Three screening rules were used to define abnormal linear growth: distance of height SDS from average height, distance of height SDS from TH (calculated from parental heights), and change in height SDS over time. A study reporting the results of the system of automated growth monitoring (AGM) has recently been published [35]. …”

Section: Automated Screening Of Growth Disorders Using Electronic Heamentioning

confidence: 99%

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

Savage

Backeljauw

Calzada³

et al. 2016

Horm Res Paediatr

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Early diagnosis is a key objective in clinical medicine, and early detection of pathological short stature has tangible benefits for growth prognosis and the well-being of the child. Despite late diagnosis being common in growth disorders, programmes of height screening in primary care are not universal in developed countries and may be random or non-existent. A notable exception is automated growth monitoring in Finland, where an algorithm to detect abnormal growth is integrated into children's electronic health records, resulting in increased diagnoses of pathological short stature. Evidence-based anthropometric criteria for referral of short stature to secondary or tertiary care are now published, due largely to excellent studies in the Netherlands. Following referral of the short child, the protocol for laboratory investigations remains somewhat controversial because in healthy children their diagnostic yield can be too low for cost-effectiveness. However, outside of tertiary academic paediatric endocrinology centres, baseline screening tests are considered worthwhile and may speed up diagnosis and treatment. Finally, auxological cut-offs cannot replace good clinical practice, and the understanding that early and effective management depends on commitment to a diagnosis and individualisation of therapy in the short child cannot be overemphasised.

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Use of Electronic Health Records for Automated Screening of Growth Disorders in Primary Care

Cited by 48 publications

References 4 publications

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

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

Modelling individual longitudinal human growth from fetal to adult life − QEPS I

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

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