Sex differences in patients referred for evaluation of poor growth

Abstract

Objectives: The objective of this study was to compare sex differences among referrals for evaluation of poor growth.

Study design: This study was based on chart reviews of all new-patient encounters at Children's Hospital of Philadelphia Diagnostic and Research Growth Center for short stature or poor growth evaluations during 2001. Outcome measures were patient growth characteristics, frequency of underlying pathology, and frequency of laboratory and radiologic investigations before referral.

Results: One hundred eighty-two boys and 96 girls were referred ( P < .0001). Girls were shorter, relative to the general population (median height z score, -2.4 vs -1.9 for boys, P = .02) and mid-parental target heights (median deficit, 1.9 vs 1.3 SD, P < .01). Differences were more pronounced starting at age 9 years. Median time to referral from initial fall-off on the growth curve was 35 months in girls and 24 months in boys (not significant). The percentage of girls (41%) with organic disease significantly exceeded that of boys (15%). Conversely, more boys (72%) than girls (48%) were of normal height or short but healthy ( P < .0001). Sex was not associated with frequency of tests before referral; neither was severity of short stature.

Conclusions: Sex differences in short stature referrals may delay diagnosis of diseases in girls while promoting overzealous evaluations of healthy boys who do not appear to be tall enough.

Figure 1

Histogram of height z scores at time of referral. Percentage of girls (gray) and boys (black) whose height measured within each 0.5 SD interval is depicted.

Figure 2

Histogram of deficits from mid-parental target heights at time of referral. Percentage of girls (gray) and boys (black) whose height deficit from their mid-parental target fell within each 1 SD interval is depicted.

Figure 3

Histogram of time to referral. Percentage of girls (gray) and boys (black) whose time to referral lasted within each 20-month interval is depicted.

Figure 4

Histogram of male percentages by age. Number of children referred at each age is shown above each column; column heights depict percentage of each annual grouping that is male (50% is indicated by horizontal line).