身材矮小转诊病例的评估：一项回顾性病历审查。

Evaluation of referrals for short stature: A retrospective chart review.

作者信息

Yue David, Miller Michael R, Clarson Cheril L

机构信息

Children's Hospital, London Health Sciences Centre, London, Ontario.

Lawson Health Research Institute, University of Western Ontario, London, Ontario.

出版信息

Paediatr Child Health. 2019 May;24(2):e74-e77. doi: 10.1093/pch/pxy079. Epub 2018 Jun 13.

DOI:10.1093/pch/pxy079

PMID:30996610

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6462116/

Abstract

BACKGROUND

Referrals to paediatric endocrine clinics for short stature are common. Height velocity (HV) is an essential component of the evaluation of short stature as growth deceleration often reflects an underlying paediatric endocrine diagnosis (PED). Access to previous measurements facilitates prompt calculation of HV.

OBJECTIVE

To determine the availability of previous measurements at time of referral for short stature and to determine predictors of a PED.

METHODS

A retrospective chart review was performed on all referrals for short stature to a single paediatric endocrinologist between January 2008 and December 2014. Standard practice following receipt of a referral for short stature included repeated requests to the referring physician for previous measurements.

RESULTS

A total of 324 charts of patients aged 11 months to 18 years were reviewed and 286 were eligible for inclusion. Previous measurements were available in 72.4%, and 44.8% of these were found to have a PED. There was a significant relation between HV<25th percentile and a PED (P<0.0001) and between height deficit (HD) and a PED (P<0.0001). Logistic regression analysis showed that a HV<25th percentile and a HD>2 standard deviations, increased the odds of PED by a factor of 5.12 (P<0.001) and 1.39 (P<0.005), respectively.

CONCLUSION

HV is a significant predictor of a PED. Our higher rate of previous measurement availability is likely due to our effective referral screening protocol. The availability of these measurements, which are essential for HV calculation, are likely to reduce delays in diagnosis and management.

摘要

背景

因身材矮小转诊至儿科内分泌门诊的情况很常见。身高增长速度（HV）是评估身材矮小的重要组成部分，因为生长减速往往反映了潜在的儿科内分泌诊断（PED）。获取既往测量数据有助于迅速计算HV。

目的

确定身材矮小转诊时既往测量数据的可获得性，并确定PED的预测因素。

方法

对2008年1月至2014年12月间转诊至一位儿科内分泌专家处的所有身材矮小患者的病历进行回顾性分析。收到身材矮小转诊后，标准做法包括多次向转诊医生索要既往测量数据。

结果

共审查了324例年龄在11个月至18岁之间患者的病历，其中286例符合纳入标准。72.4%的患者有既往测量数据，其中44.8%被诊断为PED。HV低于第25百分位数与PED之间存在显著相关性（P<0.0001），身高不足（HD）与PED之间也存在显著相关性（P<0.0001）。逻辑回归分析显示，HV低于第25百分位数和HD>2个标准差分别使PED的几率增加5.12倍（P<..001）和1.39倍（P<0.005）。