漏斗胸の子供の装具治療成績予測スコアの開発：単一施設の後ろ向き研究

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.

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.

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).

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.