GP9 Skull X-rays in the diagnosis of abnormal skull shapes

Abstract

Introduction Differentiation between plagiocephaly and craniosynostosis continues to provide a challenge for the clinician. Historically, initial investigations would have included a skull x-ray. However, it is widely accepted that this investigation is difficult to interpret and its value in diagnosis of craniosynostosis is debated. Aside from creating the burden of additional investigations, it also exposes children to ionising radiation. Aim and Objectives Examine the correlation between reported skull x-rays and clinical diagnosis of craniosynostosis to establish their diagnostic value and value in management of abnormal skull shape. Methods Retrospective chart review conducted as a 2 part study in children who were referred with a skull x-ray. Part A: Referrals of abnormal skull shapes to the National Pediatric Craniofacial Center (NPCC), Temple Street Children’s Hospital, between 1st January 2015 and 30th May 2017 Part B: Children who underwent surgery for a confirmed craniosynostosis between 1st January 2011 - 25th October 2017. Results and Findings Part A: 300 children were referred with 59 skull x-rays. This represented 20% of all patients referred during the time period. Of these 44 (75%) were found to be a match with 15 (25%) not matching the final clinical diagnosis. Part B: 274 children underwent surgery for a confirmed craniosynostosis between 1st January 2011 - 25th October 2017. 63 pts had skull x-rays on referral- this represents 23% of all operated children in the time period. Of these 41 (63%) were found to be a match with 17 (29%) not matching the final clinical diagnosis. 5 (8%) were inconclusive. Conclusions Part A: In 25% of the children referred to the NPCC with abnormal skull shape, their clinical diagnosis did not match their x-ray report. As such, skull x-rays did not contribute to their management. Part B: In 35% of children who underwent surgery for craniosynostosis, their clinical diagnosis did not match their radiological diagnosis. In the remaining children who had a skull x-ray performed and underwent surgery for craniosynostosis, the majority (88%) had a subtype of craniosynostosis which our clinical team who feel confident to diagnosis clinically without imaging. As such, it can be said that in 92% of children who underwent surgery at the NPCC the x-ray did not contribute to their management. We recommend clinicians should check with the NPCC with respect to the protocol for x-rays where craniosynostosis is suspected as in most cases the diagnosis is clinically obvious to the craniofacial surgeon.