Desarrollo de una puntuación predictiva clínica para los resultados del corsé en niños con Pectus Carinatum: Un estudio retrospectivo unicéntrico
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Published on: October 16, 2013
Haonan Wang1, Yunyu He1, Minhua Lin2
1Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China.
Background And Objectives:
Pectus carinatum (PC) is a common chest wall deformity, but there is currently a lack of predictive models and tools for forecasting deformity improvement with Compressive Orthotic Bracing (COB) therapy.This study aimed to identify key factors influencing treatment outcomes, and to develop and integrate a predictive efficacy scoring tool with a clinical decision pathway to provide evidence-based treatment recommendations for pediatric PC patients.
Methods:
In this retrospective study, 182 pediatric PC patients evaluated and followed using 3D scanning were enrolled. A multiple linear regression model was developed to create and validate a predictive efficacy scoring tool, which subsequently informed the establishment of a treatment decision pathway.
Results:
The predictive model identified smaller initial external thoracic width (P<0.001, β=-0.644), older age at treatment initiation (P=0.04, β=0.271), good compliance (P=0.008, β=0.188), and favorable chest wall morphology (P=0.033, β=0.152) as independent predictors of deformity improvement. The model was optimized into a predictive efficacy scoring tool (Score = Expected %dEHI + 4.761). Comparison between the good-response (score>0) and poor-response (score≤0) groups confirmed the tool's excellent discriminative ability (8.348 vs. 15.320, P<0.001).
Conclusion:
Treatment recommendations were derived by integrating the scoring tool with the decision pathway: children with score>0 are strongly recommended to continue bracing; those with score≤0 due to poor compliance should receive intensified supervision, while those with score≤0 due to other factors should be counseled on possible surgery; children under 4 years require personalized recommendations integrating the score, symptoms, and parental preferences. However, as a single-center retrospective study without a control group and with subjective compliance assessment, future prospective multicenter studies are required to validate the model's generalizability.
