Selecting short-statured children needing growth hormone testing: derivation and validation of a clinical decision rule.
Selecting short-statured children needing growth hormone testing: derivation and validation of a clinical decision rule.
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DOI：
10.1186/1471-2431-8-29
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发表时间：
2008-07-16
期刊：
影响因子：
2.4
通讯作者：
Chalumeau, Martin
中科院分区：
文献类型：
--
作者：
Duche, Laetitia;Trivin, Christine;Chemaitilly, Wassim;Souberbielle, Jean Claude;Breart, Gerard;Brauner, Raja;Chalumeau, Martin
许多身材矮小的儿童被评估为生长激素（GH）缺乏症（GHD）。在大多数患者中，GH激发试验是正常的，因此回顾起来是不必要的。进行了一项回顾性队列研究，以确定矮小儿童生长激素（GH）缺乏症（GHD）的预测因子，并构建一个非常敏感和相当特异的预测工具，以避免不必要的GH激发试验。GHD定义为存在2个GH浓度峰< 10 ng/ml。确定性GHD定义为GHD和磁共振成像观察垂体柄中断综合征。独立的预测因素进行了确定与单变量和多变量分析，然后结合在一个决策规则，在另一个人口验证。最初的研究包括167名患者，其中36名（22%）患有GHD，包括5名（3%）患有某种GHD。GHD的独立预测因子为：生长速率< -1 DS（调整后的比值比：3.2; 95%置信区间[1.3-7.9]）、IGF-I浓度< -2 DS（2.8 [1.1-7.3]）和BMI z评分≥ 0（2.8 [1.2-6.5]）。一项临床决策规则表明，只有生长速率< -1 DS且IGF-I浓度< -2 DS的患者才能接受检测，这一规则对某些GHD的敏感性为100%[48-100]，对GHD的敏感性为63% [47-79]，特异性为68% [60-76]。将该规则应用于验证人群（n = 40，包括13例患有某种GHD的患者），对某种GHD的灵敏度为92% [76-100]，特异性为70% [53-88]。我们已经推导并执行了一个高度敏感的决策规则的内部验证，可以安全地帮助避免超过2/3的不必要的GH测试。在任何应用之前，都需要对该规则进行外部验证。
Numerous short-statured children are evaluated for growth hormone (GH) deficiency (GHD). In most patients, GH provocative tests are normal and are thus in retrospect unnecessary. A retrospective cohort study was conducted to identify predictors of growth hormone (GH) deficiency (GHD) in children seen for short stature, and to construct a very sensitive and fairly specific predictive tool to avoid unnecessary GH provocative tests. GHD was defined by the presence of 2 GH concentration peaks < 10 ng/ml. Certain GHD was defined as GHD and viewing pituitary stalk interruption syndrome on magnetic resonance imaging. Independent predictors were identified with uni- and multi-variate analyses and then combined in a decision rule that was validated in another population. The initial study included 167 patients, 36 (22%) of whom had GHD, including 5 (3%) with certain GHD. Independent predictors of GHD were: growth rate < -1 DS (adjusted odds ratio: 3.2; 95% confidence interval [1.3–7.9]), IGF-I concentration < -2 DS (2.8 [1.1–7.3]) and BMI z-score ≥ 0 (2.8 [1.2–6.5]). A clinical decision rule suggesting that patients be tested only if they had a growth rate < -1 DS and a IGF-I concentration < -2 DS achieved 100% sensitivity [48–100] for certain GHD and 63% [47–79] for GHD, and a specificity of 68% [60–76]. Applying this rule to the validation population (n = 40, including 13 patients with certain GHD), the sensitivity for certain GHD was 92% [76–100] and the specificity 70% [53–88]. We have derived and performed an internal validation of a highly sensitive decision rule that could safely help to avoid more than 2/3 of the unnecessary GH tests. External validation of this rule is needed before any application.
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通讯作者：
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