Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2021) 78 OC5.1 | DOI: 10.1530/endoabs.78.OC5.1

BSPED2021 Oral Communications Oral Communications 5 (5 abstracts)

Evaluating UK Referral Criteria for Children with Short Stature in a Tertiary Paediatric Endocrinology Centre

Gemma White 1 , Shakira Cosier 1 , Afiya Andrews 1 , Ruben H. Willemsen 2 , Martin O. Savage 1 & Helen L. Storr 1

1Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; 2Department of Paediatric Endocrinology, The Royal London Children’s Hospital, London, United Kingdom

Background: Childhood growth monitoring aims to identify growth failure and detect underlying pathology. According to UK guidance, height <-2.7 standard deviation score (SDS) (<0.4th percentile) is used as the referral threshold. Additional referral criteria include height deficit (HSDS-target height SDS) <-2.0 and height velocity (HV) SDS <-1.3. Lack of routine HV and mid-parental height calculation, combined with stricter cut-offs compared to other European countries means that UK screening to detect growth disorders is suboptimal.

Methods: Retrospective review of children referred with short stature to Paediatric Endocrinology clinics at the Royal London Children’s Hospital between 2016-2020. Demographics, HSDS, HVSDS and Height-THSDS were recorded at the time of referral.

Results: 143 patients were referred with short stature (SS). 51 (36%) patients had pathological SS; 28 with primary growth failure: genetic disorder (n = 6), SGA (n = 21), SHOX (n = 1) and 23 with secondary growth failure: GHD (n = 17), GH-IGF axis disorder (n = 4), coeliac disease (n = 1) and hypothyroidism (n = 1). 15 (10%) patients remain short and under investigation with no identified pathology. 48 (34%) had non-pathological SS: FSS (n = 30), CDGP (n = 18). 29 (20%) patients did not have short stature (HSDS >2.0 and <1.6 SDS below TH). Height SDS and height-THSDS were significantly lower in the pathological SS group (n = 66) vs the non-pathological SS/normal stature group (n = 77) (-2.67 ±0.82 vs -1.97 ±0.70; P < 0.001 and -2.07 ±1.02 vs -1.06 ±0.99; P < 0.001, respectively). HV SDS did not differ between the groups (-0.49 ±2.71 vs -0.16 ±2.82; P = 0.49). The sensitivity and specificity to detect pathology was 41% and 83% for height SDS <-2.7, 48% and 83% for HSDS-THSDS <-2.0 and 33% and 68% for HVSDS <-1.3.

Conclusion: Children with pathological short stature were significantly smaller and deviated more from target height. A significant proportion of the children with pathology had height SDS above the referral threshold, suggesting the UK cut-off may be too strict. Routine assessment of target height deficit could improve the sensitivity for identifying pathological short stature and prevent unnecessary referrals.

Volume 78

48th Meeting of the British Society for Paediatric Endocrinology and Diabetes

Online, Virtual
24 Nov 2021 - 26 Nov 2021

British Society for Paediatric Endocrinology and Diabetes 

Browse other volumes

Article tools

My recent searches

No recent searches.