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Effectiveness and safety of independent pediatric nurse practitioners in evaluating plagiocephaly
Anna A Kuang1, Curtis Bergquist, Lisa Crupi
1Portland, Ore. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Child Development and Rehabilitation Center, and Department of Neurological Surgery, Oregon Health & Science University.
Insights
Pediatric nurse practitioners can accurately screen infants for positional plagiocephaly versus synostosis. This approach safely identified deformities, with no synostosis diagnoses missed, enabling effective treatment without surgeon intervention for many.
Area of Science:
- Craniofacial disorders
- Pediatric nursing
- Medical diagnostics
Background:
- The
- Back to Sleep
- program led to increased infant posterior plagiocephaly.
- A dedicated plagiocephaly screening clinic was established in 2000.
Purpose of the Study:
- To evaluate the accuracy of pediatric nurse practitioners in screening infants for positional plagiocephaly versus synostosis.
- To assess the safety and efficacy of independent screening by nurse practitioners in a craniofacial disorders program.
Main Methods:
- Retrospective review of electronic medical records from 2005-2011.
- Analysis of patients independently screened by pediatric nurse practitioners for plagiocephaly.
- Comparison of diagnoses and treatment outcomes between nurse practitioner-managed and surgeon-referred patients.
Main Results:
- Over 1200 patients were screened; over half managed without direct surgeon input.
- 26% received helmet therapy, 60% received counseling/physical therapy for torticollis.
- No synostosis was missed by nurse practitioners; 48% were referred for surgical consultation, with 121 confirmed synostosis cases.
Conclusions:
- Pediatric nurse practitioners accurately differentiate positional plagiocephaly from synostosis.
- Nurse practitioner-led screening is safe and effective in high-volume craniofacial clinics.
- Specialized training enables independent and reliable screening for plagiocephaly.
Background:
The American Academy of Pediatrics Back to Sleep program in 1992 dramatically increased the incidence of posterior plagiocephaly in infants. In 2000, the craniofacial disorders program at Oregon Health & Science University established a plagiocephaly screening clinic staffed by pediatric nurse practitioners.
Methods:
Electronic medical records of patients seen in a single accredited craniofacial disorders clinic from 2005 to 2011 were reviewed retrospectively to identify patients screened independently by pediatric nurse practitioners for positional plagiocephaly versus synostosis.
Results:
Over a 7-year period, 1228 patients were independently screened. Over half [638 patients (52 percent)] were followed through subsequent visits for craniofacial disorders without any direct surgeon input. Of these, 169 (26 percent) were treated with orthotic consultation for a molding helmet, 385 (60 percent) received a combination of counseling and/or physical therapy for torticollis, and 84 (13 percent) were lost to follow-up. No patient managed by pediatric nurse practitioners was identified to have cranial synostosis and no patient underwent early or delayed surgery. All returning patients [n=554 (86 percent)] showed improvement in, or resolution of, their presenting deformity. The remaining 590 patients (48 percent) were referred by the pediatric nurse practitioner for surgical consultation. Computed tomographic imaging revealed synostosis in 121 patients.
Conclusions:
Pediatric nurse practitioners accurately screened over half of patients referred to a high-volume craniofacial disorders program for positional plagiocephaly versus synostosis, without surgeon input. Based on available information, no synostosis diagnosis was overlooked using this approach. With specific training, pediatric nurse practitioners working in a craniofacial disorders program can safely and independently screen for positional versus synostotic plagiocephaly.
Clinical Question/Level Of Evidence:
Diagnostic, III.
