Referral pattern and surgical outcome of sagittal synostosis
Justin S Chatterjee1, Mahtab Mahmoud, Shanmugam Karthikeyan
1The Birmingham Craniofacial Unit, Birmingham Children's Hospital, Birmingham, UK. justinchatterjee@yahoo.co.uk
Insights
Early surgery for sagittal synostosis (SS) improves head shape outcomes. Delayed referrals, often from general practitioners, are linked to poorer results, suggesting a need for faster referral systems to enhance surgical success.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Sagittal synostosis (SS) is the most common craniosynostosis.
- Management strategies include strip craniectomy (infants <6 months) and calvarial remodeling (infants >6 months).
- The cephalic index (CI) is used to objectively measure head shape.
Purpose of the Study:
- To analyze referral patterns for SS.
- To investigate the correlation between age at operation and cephalic index (CI).
- To evaluate the impact of referral timing on surgical outcomes.
Main Methods:
- Retrospective review of 47 patients referred for SS (July 1999 - December 2003).
- Analysis of 33 non-syndromic SS patients' demographics, referral data, and pre/postoperative CI measurements.
- Comparison of CI changes based on age at operation.
Main Results:
- Paediatricians referred 91% of cases (mean age 15 months); GPs referred 9% (all >6 months).
- Significant improvement in CI for patients operated before 12 months (P=0.02).
- No significant CI difference observed for patients operated after 12 months.
Conclusions:
- Early surgical intervention for SS is associated with better aesthetic outcomes.
- Later referrals correlate with more complex referral pathways.
- A streamlined referral system for healthcare providers could improve surgical results for SS.
Summary:
Sagittal synostosis (SS) is the commonest form of craniosynostosis, and in the Birmingham Craniofacial Unit has been preferably managed by strip craniectomy when the baby is under 6 months of age or calvarial remodelling when over 6 months old. The unit uses cephalic index (CI) as an objective measure of head shape. This retrospective study analysed referral patterns and the correlation between age at operation and CI. Patients' unit notes and images of 47 patients referred for SS between July 1999 and December 2003 were reviewed. Thirty-three non-syndromic SS patients were studied and demographics, referral information and preoperative and postoperative CI measurements were recorded. Paediatricians referred 91% (mean age 15 months) of cases and general practitioners 9% (all beyond 6 months). There was a significant difference between pre- and postoperative CI for patients operated at less than 12 months (P=0.02). No difference was demonstrated for patients operated at greater than 12 months.
Conclusion:
Early surgery for SS was associated with a better aesthetic result in this series, although CI may be a crude form of head shape analysis. Later referral was associated with a more complex referral pathway. A fast track system for general practitioners and paediatricians to aid early referrals may improve surgical outcome.
