Cotterill A M, Majrowski W H, Hearn S, Jenkins S, Preece M A, Savage M O
Department of Endocrinology, St Bartholomew's Hospital, London.
Arch Dis Child. 1996 May;74(5):452-4. doi: 10.1136/adc.74.5.452.
The UK 1990 height charts are derived from an up to date dataset and introduce a change in the centile lines, particularly the addition of the 0.4th centile. This study examined the likely impact of these changes. Height data from London school children (1990-1993) were examined using Tanner and Whitehouse (TW) and UK 1990 charts. Numbers of children with height below TW 3rd centile were compared with numbers below the UK 1990 3rd and 0.4th centiles. The TW charts identified only 1% of children below the TW 3rd centile, while the UK 1990 charts identified 3% below the 3rd and 0.4% below the 0.4th centiles. If the 3rd centile remains as the referral 'cut off' for short stature, the introduction of the UK 1990 charts would increase current workload two- to three-fold, while a change to the 0.4th centile would reduce it by 50%. A significant number of children with abnormalities may be excluded from further assessment as a result of this latter change. In this small scale community study it is not possible to assess the consequences of this change. The heights at diagnosis of children with growth hormone (GH) deficiency (peak GH < 20 mU/l during a standard provocation test) were therefore compared to the 0.4th centile (UK 1990 charts). Sixty eight children with heights < 2nd centile (UK 1990 charts) currently receiving GH replacement (17 female, 51 male, aged 9.7, SD 3.5, years) were assessed, and of these, 28 (41%) had heights at diagnosis between 0.4th and 2nd centile, with a mean height standard deviation score of -2.32 (SD 0.21). This suggests that if the 0.4th centile were to be used as the sole criterion for referral for slow growth, a significant proportion of children with abnormality would not be referred for further assessment. The UK 1990 2nd centile should replace the TW 3rd centile. Children below this should undergo an intermediary medical assessment to confirm height measurement, to exclude from referral children with mild familial short stature and to identify concerns regarding the child.
英国1990年身高图表源自最新数据集，百分位线有所变化，尤其是增加了第0.4百分位。本研究探讨了这些变化可能产生的影响。使用坦纳和怀特豪斯（TW）图表以及英国1990年图表对伦敦学童（1990 - 1993年）的身高数据进行了分析。将身高低于TW第3百分位的儿童数量与低于英国1990年第3百分位和第0.4百分位的儿童数量进行了比较。TW图表识别出低于TW第3百分位的儿童仅占1%，而英国1990年图表识别出低于第3百分位的儿童占3%，低于第0.4百分位的儿童占0.4%。如果将第3百分位作为身材矮小转诊的“临界值”，采用英国1990年图表会使当前工作量增加两到三倍，而改为第0.4百分位则会使其减少50%。后一种变化可能会导致大量有异常的儿童被排除在进一步评估之外。在这项小规模社区研究中，无法评估这种变化的后果。因此，将生长激素（GH）缺乏症患儿（在标准激发试验中峰值GH < 20 mU/l）诊断时的身高与第0.4百分位（英国1990年图表）进行了比较。对68名身高低于第2百分位（英国1990年图表）且目前正在接受GH替代治疗的患儿（17名女性，51名男性，年龄9.7岁，标准差3.5岁）进行了评估，其中28名（41%）在诊断时的身高处于第0.4百分位和第2百分位之间，平均身高标准差分数为 -2.32（标准差0.21）。这表明，如果将第0.4百分位用作生长缓慢转诊的唯一标准，很大一部分有异常的儿童将不会被转诊进行进一步评估。英国1990年的第2百分位应取代TW第3百分位。低于此标准的儿童应接受中间医学评估，以确认身高测量结果，排除家族性轻度身材矮小的儿童，以及确定对该儿童的担忧情况。
