Abstract
BackgroundGrowth monitoring of apparently healthy children aims at early detection of serious conditions through the use of both clinical expertise and algorithms that define abnormal growth. Optimization of growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization.ObjectiveTo obtain a consensus about the priority target conditions for algorithms monitoring children's growth.MethodsWe applied a formal consensus method with a modified version of the RAND/UCLA method, based on three phases (preparatory, literature review, and rating), with the participation of expert advisory groups from the relevant professional medical societies (ranging from primary care providers to hospital subspecialists) as well as parent associations. We asked experts in the pilot (n = 11), reading (n = 8) and rating (n = 60) groups to complete the list of diagnostic classification of the European Society for Paediatric Endocrinology and then to select the conditions meeting the four predefined criteria of an ideal type of priority target condition.ResultsStrong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma (in decreasing order of agreement).ConclusionThis national consensus can be used to evaluate the algorithms currently suggested for growth monitoring. The method used for this national consensus could be re-used to obtain an international consensus.
Highlights
The objective of monitoring the growth of apparently healthy children is to detect serious conditions early [1]
Strong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma
Improving the performance of growth monitoring requires the standardization of definitions and practices as well as answers to two interlinked questions: What conditions should be targeted in priority? How do we define abnormal growth? The selection of the priority target conditions must precede the definition of abnormal growth by algorithms, because, as we have shown, their performance depends on the target conditions [10,11]
Summary
The objective of monitoring the growth of apparently healthy children is to detect serious conditions early [1]. Six conditions have been included in the construction or validation of the algorithms currently proposed to define abnormal growth: growth hormone deficiency, celiac disease, cystic fibrosis, Turner syndrome, small-for-gestational-age (SGA) with no catch-up after two or three years, and renal tubular acidosis [10]. This very small number should be compared with the much longer lists (up to 118) of conditions that might affect growth proposed by medical professional groups [12,13,14,15]. Optimization of growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization
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