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A Physician-Centered Craniofacial Asymmetry Index for the Severity of Plagiocephaly: A Comparative Study of
Chien-Han Lee1, Ting-Hsuan Lin2, Shih-Heng Chen3
1From the Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
Insights
A new craniofacial asymmetric index (CAI) offers objective assessment for infant plagiocephaly, aligning perfectly with surgeon judgment. This tool improves diagnostic accuracy and patient satisfaction in treating head asymmetry.
Area of Science:
- Craniofacial surgery
- Pediatric orthopedics
- Medical imaging analysis
Background:
- Infant plagiocephaly, characterized by diagonal head asymmetry, is currently diagnosed subjectively by physicians.
- Discrepancies in diagnosis between physicians and parents can lead to dissatisfaction with treatment outcomes.
- There is a need for an objective assessment system to complement clinical diagnoses of infant head asymmetry.
Purpose of the Study:
- To develop and validate an objective assessment system for infant plagiocephaly.
- To compare the novel craniofacial asymmetric index (CAI) with existing methods and expert clinical judgment.
- To enhance the accuracy and consistency of plagiocephaly severity classification.
Main Methods:
- 3D scanning was used to model infant heads.
- A craniofacial asymmetric index (CAI) was developed using 10 height planes and weighted factors.
- CAI was compared against the traditional craniofacial vault asymmetry index (CVAI) and 11 surgeons' assessments in 10 infants undergoing helmet therapy.
- Pearson correlation and Bland-Altman analysis assessed agreement; intraclass correlation evaluated inter-physician reliability.
Main Results:
- The CAI demonstrated perfect alignment with craniofacial surgeons' severity classifications (severe, moderate, mild).
- The CVAI and MATLAB analysis showed significant discrepancies compared to surgeon judgment (6 and 4 distinct results, respectively).
- Correlation coefficients showed CAI (1.000) and CVAI (0.833) strongly correlating with surgeon scores, surpassing MATLAB analysis (0.500).
- Bland-Altman plots indicated the best agreement between CAI and physician assessments.
Conclusions:
- The developed craniofacial asymmetric index (CAI) provides an objective and reliable measure for assessing infant plagiocephaly severity.
- CAI closely aligns with expert clinical judgment, offering a valuable tool to supplement subjective diagnoses.
- This objective system has the potential to improve treatment outcomes and patient satisfaction by ensuring consistent and accurate assessments.
Background:
Plagiocephaly, wherein infants' head exhibits a diagonal asymmetry, is currently diagnosed based on physicians' subjective judgment. Discrepancies between physician and parent perspectives may result in dissatisfaction with treatment outcomes. This problem highlights the need for an objective assessment system aligning with physician-made clinical diagnoses.
Methods:
Infant heads were modeled using 3-dimensional scanning techniques. We developed a craniofacial asymmetric index (CAI) based on 10 height planes of heads with varying weight. CAI and traditional craniofacial vault asymmetry index (CVAI) of 10 infants undergoing helmet therapy were compared with 11 craniofacial surgeons' judgment. The Pearson correlation coefficient and Bland-Altman plot were used to determine the correlations and agreement between physicians' judgment and the aforementioned assessment methods. The adjusted intraclass correlation coefficient was calculated to evaluate the reliability of between-physician agreement.
Results:
All 10 infants were divided into the following 3 severity groups: severe, moderate, and mild groups based on craniofacial surgeons' judgment. Notably in CAI, front/back halves of skull and multiangular weighting factors were evaluated. The evaluation revealed perfect alignment in severity classification between the CAI and physicians' judgment, whereas both the CVAI score and MATLAB analysis show varying degrees of difference, 6 and 4 distinct results, respectively. Coefficients of the correlations of physician-assigned scores with the MATLAB analysis, CVAI score, and CAI score were 0.500, 0.833, and 1.000, respectively. Furthermore, Bland-Altman plots revealed the best agreement between CAI and physician-assigned scores.
Conclusions:
CAI closely aligns with the subjective judgment of craniofacial surgeons' assessing the severity of plagiocephaly in infants.
