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In most patients, GH provocative tests are normal and are thus in retrospect unnecessary.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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 &lt; 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 &lt; -1 DS (adjusted odds ratio: 3.2; 95% confidence interval [1.3\u20137.9]), IGF-I concentration &lt; -2 DS (2.8 [1.1\u20137.3]) and BMI z-score \u2265 0 (2.8 [1.2\u20136.5]). A clinical decision rule suggesting that patients be tested only if they had a growth rate &lt; -1 DS and a IGF-I concentration &lt; -2 DS achieved 100% sensitivity [48\u2013100] for certain GHD and 63% [47\u201379] for GHD, and a specificity of 68% [60\u201376]. Applying this rule to the validation population (n = 40, including 13 patients with certain GHD), the sensitivity for certain GHD was 92% [76\u2013100] and the specificity 70% [53\u201388].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1471-2431-8-29","type":"journal-article","created":{"date-parts":[[2009,8,7]],"date-time":"2009-08-07T09:29:17Z","timestamp":1249637357000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Selecting short-statured children needing growth hormone testing: Derivation and validation of a clinical decision rule"],"prefix":"10.1186","volume":"8","author":[{"given":"La\u00ebtitia","family":"Duch\u00e9","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Trivin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wassim","family":"Chemaitilly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Claude","family":"Souberbielle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00e9rard","family":"Br\u00e9art","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raja","family":"Brauner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Chalumeau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2008,7,16]]},"reference":[{"key":"206_CR1","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1016\/j.jpeds.2003.12.036","volume":"144","author":"JL Mills","year":"2004","unstructured":"Mills JL, Schonberger LB, Wysowski DK, Brown P, Durako SJ, Cox C, Kong F, Fradkin JE: Long-term mortality in the United States cohort of pituitary-derived growth hormone recipients. 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