Fayter D, Nixon J, Hartley S, Rithalia A, Butler G, Rudolf M, Glasziou P, Bland M, Stirk L, Westwood M
Centre for Reviews and Dissemination, University of York, York, UK.
Arch Dis Child. 2008 Apr;93(4):278-84. doi: 10.1136/adc.2006.109843. Epub 2007 May 2.
To determine the effectiveness and cost-effectiveness of height screening (of children aged 4 to 11) to identify height-related conditions.
Systematic review and economic modelling.
We included published and unpublished screening studies of any design, except case reports, conducted in any setting that measured children's height as part of a population-level assessment. Studies were identified by electronic database searches, contact with experts and from bibliographies of retrieved studies.
Children aged between 4 and 11 years.
Diagnostic yield of height-related conditions and change in quality of life, as measured by quality-adjusted life years (QALYs), for early versus late treatment of underlying conditions.
Twelve studies described a height-screening programme and provided data on the diagnostic yield of newly diagnosed height-related conditions. Where reported, yield for growth-hormone deficiency (per 1000 children screened) ranged from 0.05 (1 in 20,000) to 0.62 (approximately 1 in 1500) and for Turner syndrome (per 1000 children screened) was between 0.02 (1 in 50,000) and 0.07 (approximately 1 in 14,000). As a secondary gain, children with other potentially treatable conditions were identified; diagnostic yields ranged from 0.22 to 1.84 per 1000 children screened. Three studies did not detect any new cases, but all of these studies had methodological limitations. Economic modelling suggested that height screening is associated with health improvements and is cost effective for a willingness to pay threshold of pound 30,000 per QALY.
This review indicates the utility and acceptable cost-effectiveness of height screening arising from increased detection of height-related disorders and secondary pick-up of other undiagnosed conditions. Further research is needed to obtain more reliable data on quality of life gains and costs associated with early interventions for height-related conditions. The exact role of height-screening programmes in improving child health remains to be determined.
确定（对4至11岁儿童进行的）身高筛查在识别与身高相关疾病方面的有效性和成本效益。
系统评价和经济建模。
我们纳入了已发表和未发表的、任何设计类型的筛查研究（病例报告除外），这些研究在任何背景下开展，且将测量儿童身高作为人群水平评估的一部分。通过电子数据库检索、与专家联系以及从检索到的研究的参考文献中识别研究。
4至11岁儿童。
与身高相关疾病的诊断检出率，以及根据质量调整生命年（QALY）衡量的、潜在疾病早期与晚期治疗在生活质量方面的变化。
12项研究描述了身高筛查项目，并提供了新诊断出的与身高相关疾病的诊断检出率数据。报告显示，生长激素缺乏症的检出率（每1000名接受筛查的儿童）在0.05（20000分之一）至0.62（约1500分之一）之间，特纳综合征的检出率（每1000名接受筛查的儿童）在0.02（50000分之一）至0.07（约14000分之一）之间。作为次要收获，还识别出了患有其他潜在可治疗疾病的儿童；每1000名接受筛查的儿童的诊断检出率在0.22至1.84之间。3项研究未检测到任何新病例，但所有这些研究都存在方法学上的局限性。经济建模表明，身高筛查与健康改善相关，对于每QALY支付意愿阈值为30000英镑而言，具有成本效益。
本综述表明，由于对与身高相关疾病的检测增加以及对其他未诊断疾病的二次检出，身高筛查具有实用性且成本效益可接受。需要进一步研究以获取关于与身高相关疾病早期干预相关的生活质量改善和成本的更可靠数据。身高筛查项目在改善儿童健康方面的确切作用仍有待确定。
