Medically underserved girls receive less evaluation for short stature

Journal Name: 
Pediatrics
Authors: 
Grimberg,A.
Feemster,K.A.
Pati,S.
Ramos,M.
Grundmeier,R.
Cucchiara,A.J.
Stallings,V.A.
Abstract: 
OBJECTIVE: To determine if gender is associated with diagnostic evaluation by primary care pediatricians caring for children with growth-faltering. PATIENTS AND METHODS: This was a retrospective study of children who were attending 4 urban pediatric primary care practices affiliated with a tertiary pediatric hospital. Growth-faltering was defined as height at the /= 1.5 SDs before 18 months of age or >/= 1 SD thereafter. For each child, height z score, age, gender, race, insurance, diagnostic tests, and subspecialist appointments were examined. RESULTS: Of 33 476 children, 3007 had growth-faltering (mean height: -1.5 +/- 1.0 vs 0.3 +/- 0.9 SDs in those without growth-faltering). Boys comprised 53% of the growth-faltering group (vs 51% of the nonfaltering group; P < .01). Among children with growth-faltering, 2.8% had endocrinology appointments (vs 0.8% of others; P < .0001) and 6% had gastroenterology appointments (vs 1.5% of others; P < .0001). Subspecialty care was not associated with gender. Pediatricians ordered diagnostic tests for a significantly greater proportion of children with growth-faltering than others. In multivariate analysis of height z score among children with growth-faltering, tests for chromosomes (1.4% of short girls vs 0.4% of short boys; P < .005) and growth hormone/insulin-like growth factor axis (0.9% of short girls vs 1.8% of short boys; P < .05) were associated with gender. Thirty-five percent of the girls for whom chromosome testing was performed were 12 years old or older. CONCLUSIONS: Patterns in diagnostic testing of children with growth-faltering by their pediatricians may lead to underdiagnosis of Turner syndrome and growth hormone deficiency among girls
4
2011
Volume: 
127
Pages: 
696-702
Keywords: 
Adolescent, analysis, blood, Child, Child,Preschool, Cross-Sectional Studies, deficiency, Diagnosis, diagnostic, Down Syndrome, Dwarfism, electronic, Electronic Health Records, epidemiology, evaluation, Female, Genetic Testing, genetics, Growth, Growth Charts, Health Services Accessibility, hospital, Hospitals,Pediatric, Human, Human Growth Hormone, Humans, Infant, Insurance, Lead, Male, Medicaid, Medically Uninsured, Medicine, Methods, Multivariate Analysis, older, Outpatient Clinics,Hospital, patient, Patients, Pediatrics, Pennsylvania, Philadelphia, Poverty, primary care, race, Referral and Consultation, Research, Research Support, Retrospective Studies, Sex Factors, Somatomedins, statistics & numerical data, support, Thyroid Function Tests, Turner Syndrome, United States, Universities, Urban Population, Young Adult