Assessment of Head Shape by Craniofacial Teams: Structuring Practice Parameters to Optimize Efficiency
Chad A Purnell1, Alexandra W Benz, Arun K Gosain
1Division of Pediatric Plastic Surgery, Lurie Children's Hospital of Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
High-volume practices increasingly use dedicated clinics, laser scanners, and licensed independent providers for head shape abnormalities. This shift aids in managing the rise in positional plagiocephaly referrals.
Area of Science:
- Craniofacial Surgery
- Pediatric Plastic Surgery
- Medical Device Technology
Background:
- Referrals for positional plagiocephaly have surged 600% since 1992.
- Increased patient volume complicates differentiating positional head shape issues from craniosynostosis.
- Positional plagiocephaly often requires conservative management like helmets or positioning, but accurate diagnosis is crucial.
Purpose of the Study:
- To investigate how medical practices manage the growing number of head shape abnormality patients.
- To identify differences in management strategies between low, medium, and high-volume practices.
- To understand the adoption of specific diagnostic tools and staffing models in response to increased patient load.
Main Methods:
- An electronic survey was distributed to members of the American Society of Maxillofacial Surgeons and the American Cleft Palate Association (ACPA).
- Practices were stratified into low (<4/month), medium (5-20/month), and high (>21/month) patient volume categories.
- Pearson's chi-squared test was employed to analyze significant differences in practice characteristics based on volume.
Main Results:
- High-volume centers (80%) are significantly more likely to have dedicated head shape clinics (P < 0.0005).
- Stationary laser scanners are utilized by 33.3% of high-volume practices (P = 0.023).
- Licensed independent providers (LIPs) are involved in initial evaluations in 53.3% of high-volume settings (P = 0.032).
Conclusions:
- High-volume practices demonstrate distinct management approaches for head shape abnormalities.
- These practices are more inclined to adopt advanced technologies like stationary laser scanners.
- The integration of LIPs and dedicated clinics signifies a strategic adaptation to increased patient caseloads.
Introduction:
Since the initiation of the "Back to Sleep Campaign" by the American Academy of Pediatrics in 1992, the incidence of referrals for positional plagiocephaly has increased by 600%. Although patients with positional plagiocephaly rarely require operative intervention, they often do require treatment with cranial molding helmets or positioning changes. The increased volume of patients makes the task of separating cases of craniosynostosis from positional head shape problems more difficult. The authors sought to determine how providers are handling this increased workload of head shape abnormality patients, especially with respect to the largest practices.
Materials And Methods:
An electronic survey was created and distributed to members of the American Society of Maxillofacial Surgeons and the American Cleft Palate Association (ACPA). Practices were categorized by head shape patient volume as low (<4 new patients/month), medium (5-20 new patients/month), and high (>21 new patients/month). A Pearson's χ test was used to determine characteristics that differed significantly with practice volume.
Results:
Response rate was 6.6%, with 88 responses. Regarding head shape evaluation, 17.6% of practices used a laser scanner (portable or stationary), 35.3% used caliper anthropometric measurements, 28.5% used two-dimensional digital photography, and 9.4% used three-dimensional digital photography. In high-volume centers, 80% had a dedicated head shape clinic (P < 0.0005), 33.3% used a stationary laser scanner (P = 0.023), and 53.3% used a licensed independent provider (LIP) such as a nurse practitioner or physician assistant in the initial evaluation of head shape abnormalities (P = 0.032). Although using a multidisciplinary clinic was not a significant difference amongst groups, the most common additional provider in multidisciplinary clinic was orthotics (68%).
Conclusions:
High-volume practices are significantly more likely to use LIPs, stationary laser scanners, and plain films, as well as organizing head shape abnormality patients into a dedicated clinic.
