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An improved spreadsheet for calculating limb length discrepancy and epiphysiodesis timing using the multiplier method.

Mills G, Nelson S - J Child Orthop (2016)

Bottom Line: Our multiplier spreadsheet function was then compared to manual calculations and other multiplier tools for accuracy and ease of use.It can easily be pasted into the EMR for ease of documentation.We recommend this method for both clinical practice and educational use.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Loma Linda University, 11175 Campus St, Loma Linda, CA, 92350, USA. gmills@llu.edu.

ABSTRACT

Purpose: The multiplier method is a technique to predict limb length discrepancy (LLD) at maturity in pediatric patients. Various tools have been developed for performing the multiplier calculations to predict LLD and timing of epiphysiodesis. These include multiplier/growth applications (apps) and a spreadsheet which have helped to facilitate LLC calculations in an efficient and easy manner. We have updated the spreadsheet to improve features for making LLD calculations and facilitate pasting data into electronic medical records (EMRs).

Methods: Tools currently in use were critically examined for features that limited their function, created possible sources of error or could be more user-friendly. These features were modified and recreated in an improved Excel spreadsheet that uses patient age, sex, limb lengths, and previous lengthening surgeries as inputs to predict LLD at maturity and offer options for timing of epiphysiodesis for both congenital and developmental LLD. Our multiplier spreadsheet function was then compared to manual calculations and other multiplier tools for accuracy and ease of use.

Results: Our spreadsheet accurately calculates LLD at maturity and timing of epiphysiodesis when compared to other methods. It contains a function to calculate predicted leg lengths after previous lengthenings, and concise single-page worksheets for developmental LLD, congenital LLD, and height prediction.

Conclusions: This spreadsheet was developed to provide a more efficient and user-friendly method of calculating LLD at maturity and timing of epiphysiodesis. It can easily be pasted into the EMR for ease of documentation. We recommend this method for both clinical practice and educational use.

No MeSH data available.


Congenital LLD worksheet
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Fig1: Congenital LLD worksheet

Mentions: This update to the spreadsheet by Sanders et al. enables the user to enter previous lengthening surgeries when calculating LLD at skeletal maturity and timing of epiphysiodesis (Figs. 1, 2) [7]. It also provides the option to enter foot height, which can be a significant contributor to congenital causes of LLD. The calculations are simplified into separate worksheets for congenital and developmental LLD which helps to differentiate these clinical scenarios and provides a clean-looking datasheet for conveniently pasting into an EMR. The date of the calculations is clearly placed at the top of the datasheet to avoid confusion when copying and updating notes in the EMR. This also allows for multiple worksheets from different dates to be copied into a single progress note so the clinician can see trends, know lengthening history, and better predict LLD. Like the first edition of this worksheet, the process of predicting LLD and appropriate timing of epiphysiodesis is simplified into a single step from the two-step process required by both of the apps. Additionally, a separate tab is included to predict adult height at skeletal maturity to assist clinicians when parents ask about their child’s growth potential. This table is similar to the adult height calculators found in both of the apps using the multiplier method for predicting adult height [8].Fig. 1


An improved spreadsheet for calculating limb length discrepancy and epiphysiodesis timing using the multiplier method.

Mills G, Nelson S - J Child Orthop (2016)

Congenital LLD worksheet
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940249&req=5

Fig1: Congenital LLD worksheet
Mentions: This update to the spreadsheet by Sanders et al. enables the user to enter previous lengthening surgeries when calculating LLD at skeletal maturity and timing of epiphysiodesis (Figs. 1, 2) [7]. It also provides the option to enter foot height, which can be a significant contributor to congenital causes of LLD. The calculations are simplified into separate worksheets for congenital and developmental LLD which helps to differentiate these clinical scenarios and provides a clean-looking datasheet for conveniently pasting into an EMR. The date of the calculations is clearly placed at the top of the datasheet to avoid confusion when copying and updating notes in the EMR. This also allows for multiple worksheets from different dates to be copied into a single progress note so the clinician can see trends, know lengthening history, and better predict LLD. Like the first edition of this worksheet, the process of predicting LLD and appropriate timing of epiphysiodesis is simplified into a single step from the two-step process required by both of the apps. Additionally, a separate tab is included to predict adult height at skeletal maturity to assist clinicians when parents ask about their child’s growth potential. This table is similar to the adult height calculators found in both of the apps using the multiplier method for predicting adult height [8].Fig. 1

Bottom Line: Our multiplier spreadsheet function was then compared to manual calculations and other multiplier tools for accuracy and ease of use.It can easily be pasted into the EMR for ease of documentation.We recommend this method for both clinical practice and educational use.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Loma Linda University, 11175 Campus St, Loma Linda, CA, 92350, USA. gmills@llu.edu.

ABSTRACT

Purpose: The multiplier method is a technique to predict limb length discrepancy (LLD) at maturity in pediatric patients. Various tools have been developed for performing the multiplier calculations to predict LLD and timing of epiphysiodesis. These include multiplier/growth applications (apps) and a spreadsheet which have helped to facilitate LLC calculations in an efficient and easy manner. We have updated the spreadsheet to improve features for making LLD calculations and facilitate pasting data into electronic medical records (EMRs).

Methods: Tools currently in use were critically examined for features that limited their function, created possible sources of error or could be more user-friendly. These features were modified and recreated in an improved Excel spreadsheet that uses patient age, sex, limb lengths, and previous lengthening surgeries as inputs to predict LLD at maturity and offer options for timing of epiphysiodesis for both congenital and developmental LLD. Our multiplier spreadsheet function was then compared to manual calculations and other multiplier tools for accuracy and ease of use.

Results: Our spreadsheet accurately calculates LLD at maturity and timing of epiphysiodesis when compared to other methods. It contains a function to calculate predicted leg lengths after previous lengthenings, and concise single-page worksheets for developmental LLD, congenital LLD, and height prediction.

Conclusions: This spreadsheet was developed to provide a more efficient and user-friendly method of calculating LLD at maturity and timing of epiphysiodesis. It can easily be pasted into the EMR for ease of documentation. We recommend this method for both clinical practice and educational use.

No MeSH data available.