Low incidence of pathology detection and high cost of screening in the evaluation of asymptomatic short children

Abstract

Objective: To determine the incidence of pathology during routine screening of healthy short children, testing adherence to a consensus statement on the diagnosis and treatment of children with idiopathic short stature, and the cost per identified diagnosis resulting from comprehensive screening.

Study design: Retrospective chart review of 1373 consecutive short stature referrals evaluated at the Cincinnati Children's Hospital Medical Center Pediatric Endocrinology Clinic between 2008 and 2011. We identified 235 patients with a height of <3rd percentile, negative history and review of systems, and normal physical examination. Outcome measures were incidence of pathology detection, diagnostic group characteristics, clinicians' adherence to testing guidelines, and screening costs. ANOVA and χ(2) were used to analyze the data.

Results: Nearly 99% of patients were diagnosed as possible variants of normal growth: 23% with familial short stature, 41% with constitutional delay of growth and maturation, and 36% with idiopathic short stature. The incidence of newly diagnosed pathology was 1.3%: 1 patient with biopsy-proved celiac disease, 1 with unconfirmed celiac disease, and 1 with potential insulin-like growth factor I receptor defect. On average, each patient had 64.3% of the recommended tests for age and sex; 2.1% of patients had all of the recommended testing. The total screening tests costs were $315321, yielding $105107 per new diagnosis entertained.

Conclusions: Healthy short children do not warrant nondirected, comprehensive screening. Future guidelines for evaluating short stature should include patient-specific testing.

Keywords: ADHD; Attention-deficit/hyperactivity disorder; BMI; Body mass index; CCHMC; CDGM; Cincinnati Children's Hospital Endocrinology Clinic; Constitutional delay of growth and maturation; ESR; Erythrocyte sedimentation rate; FSS; FT(4); Familial short stature; Free thyroxine; GH; Growth hormone; HV; Height velocity; IGF-1; ISS; Idiopathic short stature; IgA; Immunoglobulin A; Insulin-like growth factor I; T(4); TH; Target height; Thyroxine; Tissue transglutaminase; tTG.

Figure 1

Study population.

Figure 2

Diagnostic group demographics and auxology. A, Age. B, Height SDSs. C, TH SDSs. D, Height Deficit. E, Weight SDSs. F, Bone age delay. “Other” indicates 3 patients with possible pathology. *Statistical significance; P values denoted in text.