Optimisation of children z-score calculation based on new statistical techniques

Fecha de publicación: 20/12/2018

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

Martinez-Millana, A
Hulst, JM
Boon, M
Witters, P
Fernandez-Llatas, C
Asseiceira, I
Basagoiti, I
De Boeck, K

Grupos

Enfermedad celíaca e Inmunopatología digestiva

Leader

Carmen Ribes Koninckx
Unidad Mixta de Investigacion en TICs aplicadas a la reingeniería en procesos sociosanitarios (ERPSS)

Investigador Principal

María Eugenia Gas López

Abstract

Background Expressing anthropometric parameters (height, weight, BMI) as z-score is a key principle in the clinical assessment of children and adolescents. The Centre for Disease Control and Prevention (CDC) growth charts and the CDC-LMS method for z-score calculation are widely used to assess growth and nutritional status, though they can be imprecise in some percentiles. Objective To improve the accuracy of z-score calculation by revising the statistical method using the original data used to develop current z-score calculators. Design A Gaussian Process Regressions (GPR) was designed and internally validated. Z-scores for weight-for-age (WFA), height-for-age (HFA) and BMI-for-age (BMIFA) were compared with WHO and CDC-LMS methods in 1) standard z-score cut-off points, 2) simulated population of 3000 children and 3) real observations 212 children aged 2 to 18 yo. Results GPR yielded more accurate calculation of z-scores for standard cut-off points (p << 0.001) with respect to CDC-LMS and WHO approaches. WFA, HFA and BMIFA z-score calculations based on the 3 different methods using simulated and real patients, showed a large variation irrespective of gender and age. Z-scores around 0 +/- 1 showed larger variation than the values above and below +/- 2. Conclusion The revised z-score calculation method was more accurate than CDC-LMS and WHO methods for standard cut-off points. On simulated and real data, GPR based calculation provides more accurate z-score determinations, and thus, a better classification of patients below and above cut-off points. Statisticians and clinicians should consider the potential benefits of updating their calculation method for an accurate z-score determination.

Datos de la publicación

ISSN/ISSNe:: 1932-6203, 1932-6203
Tipo:: Article
Páginas:: -
DOI:: 10.1371/journal.pone.0208362
Factor de Impacto:: 1,100 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Martinez-Millana, A:: ITACA, Universitat Politècnica de València, Valencia, Spain

Univ Politecn Valencia, ITACA, Valencia, Spain
Hulst, JM:: Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands

Sophia Childrens Univ Hosp, Erasmus Med Ctr, Rotterdam, Netherlands
Boon, M:: Department of Paediatrics, University Hospital of Leuven, University of Leuven, Leuven, Belgium

Univ Leuven, Univ Hosp Leuven, Dept Paediat, Leuven, Belgium
Witters, P:: Department of Paediatrics, University Hospital of Leuven, University of Leuven, Leuven, Belgium

Univ Leuven, Univ Hosp Leuven, Dept Paediat, Leuven, Belgium
Fernandez-Llatas, C:: ITACA, Universitat Politècnica de València, Valencia, Spain

Univ Politecn Valencia, ITACA, Valencia, Spain
Asseiceira, I:: Associação Portuguesa para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal

Associacao Portuguesa Invest & Desenvolvimento, Fac Med, Lisbon, Portugal
Calvo-Lerma, J:: Instituto de Investigación. Instituto de Investigación Sanitaria La Fe, Valencia, Spain

Instituto de Investigación. Inst Invest Sanitaria La Fe, Valencia, Spain
Basagoiti, I:: ITACA, Universitat Politècnica de València, Valencia, Spain

Univ Politecn Valencia, ITACA, Valencia, Spain
Traver, V:: ITACA, Universitat Politècnica de València, Valencia, Spain

Univ Politecn Valencia, ITACA, Valencia, Spain
De Boeck, K:: Department of Paediatrics, University Hospital of Leuven, University of Leuven, Leuven, Belgium

Univ Leuven, Univ Hosp Leuven, Dept Paediat, Leuven, Belgium
Ribes-Koninckx, C:: Instituto de Investigación. Instituto de Investigación Sanitaria La Fe, Valencia, Spain

Instituto de Investigación. Inst Invest Sanitaria La Fe, Valencia, Spain