Abstract
The cranial remolding orthosis (CRO) has been shown in previous studies to be an effective method of treatment for deformational head shapes. Many studies have shown younger infants achieve greater correction than older infants and generally have a shorter treatment duration. The goal of this study is to develop and validate a prediction equation for the maximum treatment time for deformational head shapes when utilizing a CRO. This retrospective study included subjects with deformational plagiocephaly (DP), deformational brachycephaly (DB), or deformational asymmetrical brachycephaly (DAB) who began CRO treatment between 3 and 18 months of gestational age. Prediction models were derived from 1250 subjects with DP, DB, and DAB and the validation used data from 210 different subjects. Actual treatment time was less than or equal to predicted treatment time in 85.19% (DP), 56.67% (DB), and 75.40% (DAB) of the cases when rounding the prediction up to the nearest month. The prediction equation has moderate accuracy for predicting the likely maximum amount of CRO treatment time for patients with DP, DB, and DAB and may be used clinically to give caregivers an estimated treatment duration for a patient who is indicated for a CRO, if treatment was initiated immediately.
Highlights
Prediction models were derived from 1250 subjects with deformational plagiocephaly (DP), deformational brachycephaly (DB), and deformational asymmetrical brachycephaly (DAB) and the validation used data from 210 different subjects
The prediction equation has moderate accuracy for predicting the likely maximum amount of cranial remolding orthosis (CRO) treatment time for patients with DP, DB, and DAB and may be used clinically to give caregivers an estimated treatment duration for a patient who is indicated for a CRO, if treatment was initiated immediately
It is likely that the reason for the lower accuracy for DB is due to the lower number of subjects used in both the derivation and in the validation compared to DP and DAB
Summary
The infant skull can be deformed due to the application of external forces upon the skull during development [1,2]. The incidence of these deformational head shapes has dramatically increased since the American Academy of Pediatrics (AAP) began recommending supine sleep for infants and is very common among infants in the United States [3,4]. Isolated deformational plagiocephaly (DP) describes the posterior lateral flattening of the skull and a subsequent bossing of the ipsilateral forehead. Isolated deformational brachycephaly (DB) is characterized by a symmetric head shape that is wider than the norm. Deformational asymmetrical brachycephaly (DAB) has features of DB, and has asymmetry [5]
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