Towards a shared diagnostic approach for pediatric short stature: a Delphi consensus of the Italian Society of Pediatrics and the Italian Society for Pediatric Endocrinology and Diabetology

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BACKGROUND: Short stature is a common reason for referral in pediatric practice, but significant variability exists in diagnostic approaches and referral criteria. Therefore, the aim of this consensus was to improve the management of children with short stature through the knowledge and expertise of various Italian centers through a Delphi-consensus process. METHODS: A multidisciplinary scientific board of 11 experts and 1 patient advocate were involved in a consensus process and used the Delphi method. The scientific board identified 4 key domains regarding short stature: clinical evaluation, biochemical assessment, imaging and genetic investigation. Two literature searches were conducted. The first search aimed to identify international guidelines and consensus on the diagnosis of short stature in children. The second search sought to retrieve clinical studies focusing on the four domains. The results of the literature searches were evaluated by the scientific board and a total of 14 statements were drafted and submitted to a panel of 39 pediatricians and pediatric endocrinologists using a two-round Delphi method conducted between February and March 2025. Consensus was defined as ≥ 80% agreement or disagreement (scores 7–9 or scores 1–3 on a 9-point Likert scale). RESULTS: In the first Delphi round, 34 out of 39 experts responded (response rate 87%), and consensus was reached on 11 out of 14 statements. The remaining 3 statements were revised by the scientific board and re-submitted. In the second round, 34 of 34 eligible experts responded (100%), and consensus was achieved for one additional statement. Overall, a strong agreement was reached for 12 out of 14 statements. CONCLUSION: This consensus provides valuable insights and recommendations to guide pediatricians in approaching a child with short stature. By addressing clinical, biochemical, imaging and genetic domains this consensus provides a model of growth monitoring that may result in early detection and appropriate management of children with short stature.

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