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Deformational brachycephaly: the clinical utility of the cranial index
Ranbir Ahluwalia1,2, Jarrett Foster1,3, Madeleine M Sherburn1
11Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Insights
Deformational brachycephaly is common in infants but its prevalence decreases with age. The cranial index (CI) shows a significant decline in children over time, indicating skull shape improvement.
Area of Science:
- Pediatric Radiology
- Craniofacial Development
- Public Health
Background:
- The
- Back to Sleep
- campaign has been linked to an increased incidence of deformational brachycephaly.
- Understanding the prevalence and age-related changes in brachycephaly is crucial.
- The cranial index (CI) is a key metric for assessing skull shape.
Purpose of the Study:
- To determine the prevalence of deformational brachycephaly using the CI.
- To investigate the relationship between CI and age in pediatric patients.
- To analyze the dynamic changes in pediatric skull shape over time.
Main Methods:
- Retrospective review of 1499 pediatric patients (≤ 19 years) with negative CT scans for trauma.
- Cranial index (CI) calculated using CT measurements: cephalic width and length.
- Deformational brachycephaly defined as CI ≥ 90%.
Main Results:
- The mean CI was 82.6 in the study population (average age 6.8 years).
- Brachycephaly prevalence decreased from 27% at birth to 4% by age 2 years.
- A statistically significant decrease in mean CI was observed with increasing age, with CI reducing by 0.038 per month.
Conclusions:
- Deformational brachycephaly is common in infancy but significantly decreases with age.
- Clinicians can anticipate a notable reduction in mean CI at 12 and 24 months.
- Regression models indicate continued improvement in pediatric skull shape throughout childhood.
Objective:
The incidence of deformational brachycephaly has risen since the "Back to Sleep" movement in 1992 by the American Academy of Pediatrics. Brachycephaly prevalence and understanding the dynamic nature of the pediatric skull have not been explored in relation to the cranial index (CI). The objective of the study was to determine the prevalence of brachycephaly, via the CI, with respect to time.
Methods:
The authors conducted a retrospective review of 1499 patients ≤ 19 years of age who presented for trauma evaluation with a negative CT scan for trauma (absence of bleed) in 2018. The CI was calculated using CT at the lateral-most point of the parietal bone (cephalic width), and the distance from the glabella to the opisthocranion (cephalic length). Brachycephaly was defined as a CI ≥ 90%.
Results:
The mean CI was 82.6, with an average patient age of 6.8 years. The prevalence of deformational brachycephaly steadily decreased from 27% to 4% from birth to > 2 years of life. The mean CI was statistically different between ages < 12 months, 12-24 months, and > 24 months (F[2,1496] = 124.058, p < 0.0005). A simple linear regression was calculated to predict the CI based on age; the CI was found to decrease by 0.038 each month. A significant regression equation was found (F[1,1497] = 296.846, p < 0.0005), with an R2 of 0.140.
Conclusions:
The incidence of deformational brachycephaly is common in infants but decreases as the child progresses through early childhood. Clinicians can expect a significant decrease in mean CI at 12 and 24 months. Additionally, these regression models show that clinicians can expect continued improvement throughout childhood.
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