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Comparison of perceptions and treatment practices between neurosurgeons and plastic surgeons for infants with
Amy Lee1, Andrea E Van Pelt, Alex A Kane
1Department of Neurosurgery, Washington University School of Medicine and St. Louis Children's Hospital, Saint Louis, Missouri 63110, USA. leeam@nsurg.wustl.edu
Insights
Pediatric neurosurgeons are less likely than plastic surgeons to recommend helmet therapy for deformational plagiocephaly (DP). This may lead to inconsistent treatment decisions for infants with head shape abnormalities.
Area of Science:
- Pediatric surgery
- Craniofacial surgery
- Neurosurgery
Background:
- Deformational plagiocephaly (DP) is a common cause of infant head shape abnormalities.
- Current treatment options include conservative management and cranial molding helmets.
- There is a lack of consensus among pediatric neurosurgeons and craniofacial plastic surgeons regarding DP treatment standards.
Purpose of the Study:
- To investigate and compare the treatment preferences of pediatric neurosurgeons and craniofacial plastic surgeons for DP.
- To identify potential differences in the perception of DP severity and the indication for helmet therapy between specialties.
Main Methods:
- A web-based questionnaire was distributed to pediatric neurosurgeons and craniofacial plastic surgeons.
- The survey assessed demographics, practice patterns, and treatment preferences for DP, including responses to varying severity examples.
- Response rates were 24% for neurosurgeons (n=71) and 14% for plastic surgeons (n=64).
Main Results:
- Plastic surgeons were significantly more likely than neurosurgeons to agree that helmet therapy is more beneficial than conservative treatment (26% vs. 8%, p < 0.01).
- A higher percentage of plastic surgeons (58%) would opt for helmet therapy for moderate to severe DP compared to neurosurgeons (25%, p < 0.01).
Conclusions:
- Neurosurgeons appear less inclined to prescribe helmet therapy for DP compared to plastic surgeons.
- Parental decisions regarding costly DP treatments may be influenced by physician bias rather than solely by medical evidence.
Object:
Deformational plagiocephaly (DP) is the leading cause of head shape abnormalities in infants. Treatment options include conservative measures and cranial molding. Pediatric neurosurgeons and craniofacial plastic surgeons have yet to agree on an ideal therapy, and no definable standards exist for initiating treatment with helmets. Furthermore, there may be differences between specialties in their perceptions of DP severity and need for helmet therapy.
Methods:
Requests to participate in a web-based questionnaire were sent to diplomates of the American Board of Pediatric Neurological Surgery and US and Canadian members of the Pediatric Joint Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and the American Cleft Palate-Craniofacial Association. Questions focused on educational background; practice setting; volume of DP patients; preferences for evaluation, treatment, follow-up; and incentives or deterrents to treat with helmet therapy. Six examples of varying degrees of DP were presented to delineate treatment preferences.
Results:
Requests were sent to 302 neurosurgeons and 470 plastic surgeons, and responses were received from 71 neurosurgeons (24%) and 64 plastic surgeons (14%). The following responses represented the greatest variations between specialties: 1) 8% of neurosurgeons and 26% of plastic surgeons strongly agreed with the statement that helmet therapy is more beneficial than conservative therapy (p < 0.01); and 2) 25% of neurosurgeons and 58% of plastic surgeons would treat moderate to severe DP with helmets (p < 0.01).
Conclusions:
Survey responses suggest that neurosurgeons are less likely to prescribe helmet therapy for DP than plastic surgeons. Parents of children with DP are faced with a costly treatment decision that may be influenced more strongly by referral and physician bias than medical evidence.
