Frequently asked support questions
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General use
GrowthXP has a unique charting engine that produces high quality, high resolution charts of any size, on any device, from high resolution PC screens down to small devices such as mobile phones. Charts are instantly drawn using an advanced engine that produces the charting scales, reference curve, patient curve and all additional objects, such as pubertal sections, or parental height nomograms. It’s all drawn with the same methods, and always live. This ensures high quality precision in terms of positioning all objects, in particular the patient curve on the chart, and so regardless of display zoom or device.
Children born prior to 37 weeks are considered premature and if gestational age has been entered a double plot will occur on certain charts.
For children born prematurely two curves are plotted on certain charts for the first period of life (up to 2 and sometimes a bit further than that). One line is showing growth at the current age, i.e. counting from the date of birth. The other line is showing their growth according to corrected age. A child born 5 weeks early will have a horizontal line drawn back 5 weeks in time from each measurement. At this new position a second point is plotted. These corrected age points are then connected with a line to form the second curve. Arrows are pointing toward the corrected points to encourage you to use these points in your evaluation. There is a setting that allows you to temporarily suspend the double plots.
The default scaling of all charts were set to accommodate the majority of children and adolescents. However, when extreme values are encountered, and when the chart design allows it, we automatically extend the scaling so that all values for the patient are visible. This is particularly true for all charts in the two generic groups: measurements and calculated.
Yes, all the charts in the groups Measurement and Calculated automatically adjust their scale if the patient is older than 20 years. The age scale will then adjust in increments of 5 years, so instead of showing 0-20 years, the chart will show 5-25 years for a 22 year old patient.
Each version of GrowthXP comes with 60 to 100 predefined charts, and once a patient is loaded you can freely choose to display one or the other. Data automatically populates the charts depending upon the available data. Charts are organized into separate folders for faster selection. Typically there are one or two folders with charts of national layouts, then a separate chart for the newborn and premature children. These charts all have several components, with two or three parameters being displayed in the same chart, possibly inclusion of pubertal development charts, target height predictions etc. Two groups contain generic charts with a basic layout: Measurements and Calculated, covering all measurements and calculated values that GrowthXP offers. These charts are using a basic layout and only display one parameter at a time. These charts automatically extend upwards to display extreme values (especially useful for weight and bmi) but they also extend the age axis, when used with patients older than 20 years. The scaling then changes to 5-25 years, 10-30 etc. This allows these charts to be used for adults as well. In particular for weight monitoring in cases of overweight or underweight (anorexia). The charts in the groups Measurement and Calculated also have a setting to narrow the age scale down to one year. That allows you to focus on changes in any of the parameters over a short period of time, during in-depth growth monitoring, during start of treatment, or follow interventional therapy such as surgery. Finally there’s also a group with tabular reports presenting a large variety of derived variables.
Calculations
BMI is, of course, automatically calculated by the program, and several different BMI charts are available for comparison other children of the same ages. There’s also an IOTF charts with cut off values for overweight, obesity and so on. This chart also extends into adult ages for use in weight management.
Most charts have a setting that allows you to switch between the display of growth reference curves as either Percentiles or SD. For percentiles there’s often an additional option that lets you choose between several sets of percentile charts, typically 3-97 or 5-95. In some countries, UK for example, the percentile charts have the outer limits set to 0.4 – 99.6. For the reports, some will display both methods, while for others there’s either a specific SD or Percentile report, or you can use the settings dialog to select how your calculated values should be displayed.
GrowthXP will automatically calculate height velocity (and other velocites) for you by selecting the most appropriate prior visit, attempting to find one as close as possible to one year prior. The velocity is then presented in cm/year for that specific period.
National variations
To reduce complexity for the everyday user, each national version has been preconfigured with the references, charts and the calculations that are most commonly used in each country. Growth Endo, however, aimed at the endocrine specialist, includes a large selection of references to allow users to configure their own preferred set of charts.
Following the publication of the WHO dataset in 2006, the CDC choose to replace the previous US data with WHO data for the ages 0-2. It was considered that the new WHO charts better represented the growth of children being breastfed.
In the UK WHO data replaces the 0-4 year data in the national UK charts.
For most countries we also include an optional WHO chart library.
The two most common syndromes with significant growth failure are Turner syndrome and Down syndrome (trisomy 21). We’ve included syndrome specific charts, based on the national charts, for these two groups in all national versions of GrowthXP. Other syndrome specific charts might be included, but it varies from country to country. Syndrome specific charts offer an alternative view, and can be used to see how untreated patients of these categories normally grow. Use of these charts may allow earlier detection of growth deviations. For patients in these groups receiving growth promoting treatments, such as growth hormone, the normal charts can be used to see how they catch up with their peers.
The US version contains the full set of recommended charts for use in the US, thus WHO 0-2 years, CDC 2-18 years. The design of the charts also perfectly replicates the design of the CDC published charts, yet contain feature enhancements to increase usability.
In countries where multiple languages are common, most charts has a setting to allow you to temporarily switch the display language. For example the US and Canadian versions can display charts in English, Spanish or French. The Belgian version can display charts in French and Flemish.
User functionality
Any of the displayed pages can be printed along with the patient plot, and the patient data. Some pages present data as charts, whereas other present data in a tabular format for accurate document, and easy retrieval, of the recorded data.
There are a number of reports included in the chart library for display of recorded values in a tabular format.
The Settings dialog allows you to temporarily adjust the display of the current chart. Popular settings include show/hide today line, show/hide target height, show/hide bone age, and selection of reference type shown. Settings can also allow you to produce an anonymous chart for display in a presentation.
It depends on the integration, but typically data is recorded in your main EHR, along with the rest of the documentation for each visit. GrowthXP will then “receive” the data in the call to launch the GrowthXP module for display of growthcharts. In some cases GrowthXP will also allow you to record new data, or update existing data.
Exporting a PDF from the system means you are taking patient data outside of the EHR and GrowthXP, we thus oblige you to enter a password with which the file will be encrypted. In the case of the PC PAL Briefcase PDF, we also keep a copy of patient data inside the chart. Thus be more data in the chart than what is currently visible when your simply view the PDF, so we’ve decided additional data protection is necessary.
GrowthXP is normally updated yearly, but frequency may vary. Updates, once tested and certified, are then delivered to customers for local deployment. Your IT department will work with us to prepare the new version for deployment, by adjusting and updating the local configuration. Our annual license fee includes the cost of updates to GrowthXP.
As the systems are typically deployed as part of your organizations IT environment, user administration is handled by your IT department, or for integrated systems: users are automatically logged in when accessing GrowthXP directly from the EHR.
The patient ages are formatted in a human readable form using days, weeks, months and years.
The different age parts use letter suffixes (y, m, w, d) for each part.
For newborns:
– From birth and up to 6 days: show age in days (3d)
– From 1 week and until 1 month: show ages using full weeks, or weeks and days (1w, 2d)
– From 1 month, and up to 1 month and 1 week: show ages in months and days (1m, 2d)
– After 1 month and 1 week, and until 2 months: show ages in months and weeks (1m, 2w)
General age formatting rules afterwards:
– For each month, during the first week: show ages in months and days (6m, 2d)
– After the first week of each month: show ages in months and weeks (6m, 2w)
– After a complete year, during the first week: show ages in years and days (2y, 3d)
– After a complete year, after the first week and until the first month: show ages in years and weeks (2y, 2w)
– After a complete year, after the first month: show ages in years and months (2y, 5m)
Formatted ages are localized in more than 15 languages.
For example, Swedish abbreviations: å, m, v, d. French abbreviations: a, m, s, j.
Age intervals (in years, months, or weeks) are never rounded up, reflecting the precise amount of time that has elapsed