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Plagiocephaly Severity Scale to Aid in Clinical Treatment Recommendations
Mark A Holowka1, Andrew Reisner, Brian Giavedoni
1*Children's Healthcare of Atlanta †Departments of Pediatrics and Neurosurgery ‡Department of Physical Therapy, Emory University School of Medicine, Atlanta, GA.
Insights
A new severity scale for infant plagiocephaly (flat head syndrome) has been validated. This outcome-based tool helps clinicians effectively treat cranial abnormalities in infants.
Area of Science:
- Pediatric Medicine
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Infant cranial asymmetry lacks a standardized clinical treatment guide.
- Previous research identified potential outcome-based metrics for cranial asymmetry.
Purpose of the Study:
- To validate a novel, outcome-based severity scale for categorizing plagiocephaly (flat head syndrome).
- To provide a clinical tool for guiding treatment of infant cranial abnormalities.
Main Methods:
- Analysis of 224 patients with cranial asymmetries, including 207 in an experimental group and 17 in a control group.
- Collection of digital head shape data and computation of cross-correlation matrices.
- Development and validation of a 5-level clinical classification scale using regression models and ANOVA.
Main Results:
- Identification of 5 meaningful variables contributing to plagiocephaly severity.
- Creation of a 5-level classification scale with significant effects across 4 ANOVA tests.
- Model validation with an overall error rate of 12.1% across diverse patient groups.
Conclusions:
- The validated severity scale is a meaningful, outcome-based tool for clinicians treating plagiocephaly.
- The scale aids in developing effective treatment plans for infant cranial abnormalities.
- The scale demonstrates reliability across a large, heterogeneous patient sample.
Abstract:
Studies have attempted to categorize infant cranial asymmetry in a variety of ways using both observational and quantitative techniques, but none have created a clinical tool that can serve as a treatment guide based on clinical outcomes. In 2006, a research team from Children's Healthcare of Atlanta published the results of a prospective analysis of 224 patients with cranial asymmetries and their treatment outcomes. As a continuation of the previous work, the researchers have identified a plagiocephaly severity scale based on those outcomes to assist medical professionals who treat patients with cranial abnormalities. Our hypothesis is to validate the proposed severity scale that categorizes the clinical presentation and severity of plagiocephaly.Of the 224 patients enrolled, 207 patients were placed in an experimental group and 17 patients who refused treatment were placed in a control group. Digital head shape data were collected. Cross-correlation matrices were computed across variables and regression models resulted in the identification of 5 meaningful variables. A 5-level clinical classification scale was created. Five 1 × 5 analyses of variance were computed to compare each classification level.Four of the 5 analyses of variance identified significant overall effects for classification. A model was developed from the empirical data and the model was tested for accuracy, resulting in 12.1% overall error. The model was validated for both experimental and control groups.The results show that the severity scale is a meaningful outcome-based scale that assists clinicians in developing a treatment plan for treating plagiocephaly. The scale has been validated across a large heterogeneous study sample.
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