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Screening of hydrocephalus in infants using either WHO or population‐based head circumference reference charts
Author(s) -
Karvonen Marjo,
Saari Antti,
Lamidi MarjaLeena,
Selander Tuomas,
Löppönen Tuija,
Lönnqvist Tuula,
Dunkel Leo,
Sankilampi Ulla
Publication year - 2021
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.15533
Subject(s) - medicine , head circumference , hydrocephalus , population , receiver operating characteristic , circumference , newborn screening , reference values , pediatrics , standard deviation , standard score , standard error , normality , statistics , surgery , pregnancy , birth weight , mathematics , environmental health , biology , psychiatry , genetics , geometry
Abstract Aim The aim was to compare the performances of the World Health Organization (WHO) and population‐based (PB) references in the screening for hydrocephalus in infants aged <2 years. Methods We collected 341 longitudinal head circumference (HC) measurements of hydrocephalic infants and 120 181 measurements of 15 145 healthy infants from primary care. The measurements were converted into z‐scores, and a new screening parameter, change in HC standard deviation score (SDS) over time (ΔHC SDS), was calculated. Comparisons were made using receiver operating characteristics analysis and linear mixed models. Results The mean HC SDS WHO was 3.5 and the mean HC SDS PB was 2.9 in the hydrocephalic infants, and in healthy children, those numbers were 1.0 SDS WHO and 0 SDS PB , respectively. The best screening accuracy was obtained with the PB reference in combination with the ΔHC SDS parameter (AUC 0.89). The accuracy of the WHO standard could be improved to a similar level by customising the screening cut‐offs of HC SDS according to the population and combining screening parameters. Conclusions Auxology alone was not sufficient for the screening of hydrocephalus. The WHO standard should be validated in the population, and population‐specific cut‐offs for normality defined before its introduction.