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Not all very short kids need screening tests: study
Friday, May 31, 2013
By Genevra Pittman
NEW YORK (Reuters Health) - Kids who are short for their age but otherwise healthy probably don't need extensive blood tests to determine if a disease is stunting their growth, researchers said in a new study.
Of 235 short kids without symptoms who were referred for specialty testing, just three had a possible diagnosis picked up on those labs, and only one diagnosis - for celiac disease - was confirmed, researchers found.
"Most of the screening tests are for diseases you really wouldn't want to miss, but it's rare that any of those diseases (would only) present with short stature," said by Dr. Stephanie Sisley, who led the study.
Guidelines on short stature from endocrinology groups recommend lab screening for very short children, including those who don't have any problems picked up on a physical exam. That screening includes blood tests for thyroid and growth hormones as well as calcium and other nutrients.
But one of the authors of those guidelines agreed that based on the new findings, kids who are short but have no other symptoms probably don't need extensive screening.
Sisley and her colleagues reviewed the medical charts of 1,373 short children who were referred to the endocrinology clinic at Cincinnati Children's Hospital Medical Center between 2008 and 2011. Of them, 235 were below the third percentile for height and had a normal check-up and no record of having stopped growing.
A 10-year-old girl who is four feet, one inch tall would fall just below the third percentile, for example, as would a six-year-old boy who is three feet, five inches.
Few of those children underwent all tests recommended by the guidelines; the average kid had about two-thirds of them. One was diagnosed with celiac disease - when the body can't process certain grains - and two others had signs of underlying conditions but didn't finish follow-up tests.
There were 10 false-positive lab results that didn't pan out on further testing.
Altogether, the tests cost $315,321 - or $105,107 per possible diagnosis, the study team reported in The Journal of Pediatrics.
Sisley and her colleagues said their findings show many children are inappropriately referred to specialists for short stature. Rather than looking at a child's height at one point, it's more important to track it over time to see if a kid has stopped growing, they wrote.
"Any patient who really isn't growing should be checked out," Sisley, now at Baylor College of Medicine in Houston, told Reuters Health.
Dr. Alan Rogol, a professor emeritus at the University of Virginia in Charlottesville, agreed the new findings only apply to those kids who are short but have no record of growth delay.
The kids in this study "had nothing that pointed to difficulty in any system, and many of them were short kids of shorter parents," Rogol, who reviewed the study for the journal, told Reuters Health.
He and Sisley both said those kids should be followed by their pediatrician for at least six months - then referred to a specialist if they really aren't growing, or any time new symptoms show up.
"In this idealized set of kids, the things that pediatricians do best… are probably more worthwhile than sending them over to see an endocrinologist or somebody else," Rogol said.
"I think parents are most worried that they're missing something in the kid. It's actually okay to follow the growth of a patient for six months or 12 months to see if something's going on before you do specialized testing," Sisley said.
"Much of the time, if their child is otherwise healthy… the bottom line is they're probably going to be fine in the long run."
SOURCE: http://bit.ly/16vQeM9 The Journal of Pediatrics, online May 23, 2013.
NEW YORK (Reuters Health) - Kids who are short for their age but otherwise healthy probably don't need extensive blood tests to determine if a disease is stunting their growth, researchers said in a new study.
Of 235 short kids without symptoms who were referred for specialty testing, just three had a possible diagnosis picked up on those labs, and only one diagnosis - for celiac disease - was confirmed, researchers found.
"Most of the screening tests are for diseases you really wouldn't want to miss, but it's rare that any of those diseases (would only) present with short stature," said by Dr. Stephanie Sisley, who led the study.
Guidelines on short stature from endocrinology groups recommend lab screening for very short children, including those who don't have any problems picked up on a physical exam. That screening includes blood tests for thyroid and growth hormones as well as calcium and other nutrients.
But one of the authors of those guidelines agreed that based on the new findings, kids who are short but have no other symptoms probably don't need extensive screening.
Sisley and her colleagues reviewed the medical charts of 1,373 short children who were referred to the endocrinology clinic at Cincinnati Children's Hospital Medical Center between 2008 and 2011. Of them, 235 were below the third percentile for height and had a normal check-up and no record of having stopped growing.
A 10-year-old girl who is four feet, one inch tall would fall just below the third percentile, for example, as would a six-year-old boy who is three feet, five inches.
Few of those children underwent all tests recommended by the guidelines; the average kid had about two-thirds of them. One was diagnosed with celiac disease - when the body can't process certain grains - and two others had signs of underlying conditions but didn't finish follow-up tests.
There were 10 false-positive lab results that didn't pan out on further testing.
Altogether, the tests cost $315,321 - or $105,107 per possible diagnosis, the study team reported in The Journal of Pediatrics.
Sisley and her colleagues said their findings show many children are inappropriately referred to specialists for short stature. Rather than looking at a child's height at one point, it's more important to track it over time to see if a kid has stopped growing, they wrote.
"Any patient who really isn't growing should be checked out," Sisley, now at Baylor College of Medicine in Houston, told Reuters Health.
Dr. Alan Rogol, a professor emeritus at the University of Virginia in Charlottesville, agreed the new findings only apply to those kids who are short but have no record of growth delay.
The kids in this study "had nothing that pointed to difficulty in any system, and many of them were short kids of shorter parents," Rogol, who reviewed the study for the journal, told Reuters Health.
He and Sisley both said those kids should be followed by their pediatrician for at least six months - then referred to a specialist if they really aren't growing, or any time new symptoms show up.
"In this idealized set of kids, the things that pediatricians do best… are probably more worthwhile than sending them over to see an endocrinologist or somebody else," Rogol said.
"I think parents are most worried that they're missing something in the kid. It's actually okay to follow the growth of a patient for six months or 12 months to see if something's going on before you do specialized testing," Sisley said.
"Much of the time, if their child is otherwise healthy… the bottom line is they're probably going to be fine in the long run."
SOURCE: http://bit.ly/16vQeM9 The Journal of Pediatrics, online May 23, 2013.
Reuters Health
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