Oostdijk Wilma, Grote Floor K, de Muinck Keizer-Schrama Sabine M P F, Wit Jan M
Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Horm Res. 2009;72(4):206-17. doi: 10.1159/000236082. Epub 2009 Sep 29.
For early detection of pathological causes of growth failure proper referral criteria are needed, as well as a thorough clinical, radiological and laboratory assessment. In this minireview we first discuss the two consensus-based and one evidence-based guidelines for referral that have been published. The evidence-based guidelines result in a sensitivity of approximately 80% at a false-positive rate of 2%. Then, relevant clues from the medical history and physical examination are reviewed, and specific investigations based on clinical suspicion listed. In the absence of abnormal clinical findings, an X-ray of the hand/wrist and a laboratory screen are usually performed. Scientific evidence for the various components of laboratory screening is scarce, but accumulated experience and theoretical considerations have led to a list of investigations that may be considered until more evidence is available.
为了早期发现生长发育迟缓的病理原因，需要适当的转诊标准以及全面的临床、放射学和实验室评估。在这篇小型综述中，我们首先讨论已发表的两项基于共识和一项基于证据的转诊指南。基于证据的指南在假阳性率为2%时，灵敏度约为80%。然后，回顾病史和体格检查中的相关线索，并列出基于临床怀疑的具体检查。在没有异常临床发现的情况下，通常会进行手部/腕部X线检查和实验室筛查。实验室筛查各个组成部分的科学证据很少，但积累的经验和理论思考已形成一份在有更多证据之前可考虑进行的检查清单。
