Child Abuse and Deformational Plagiocephaly in a West Texas Hospital System

Abstract

Background The aim of this study was to assess deformational plagiocephaly’s (DP) predictive value in neglect and physical abuse (nonaccidental trauma [NAT]) within the pediatric population. In addition, we sought to characterize the prevalence of DP and NAT for our hospital’s mostly rural catchment area. Methods Data on hospitalized patients diagnosed with NAT and/or neglect between 2012 and 2018 were collected via retrospective chart review. All enrolled children were younger than the age of 4 years at the time of diagnosis, and those without legible head computed tomographies or magnetic resonance images during their initial hospitalization were excluded. Utilizing neuroimaging, we calculated the cranial vault asymmetry index (CVAI) and cranial index for each patient to assess for DP. Differences between the two groups were assessed using Wilcoxon’s rank-sum test for continuous variables and Fisher’s exact test for categorical variables. A p-value of 0.05 or less was considered statistically significant. All analyses were conducted using SAS 9.4 (Cary, North Carolina, United States). Results The prevalence of DP within the combined cohort of NAT and neglect patients is 21%, similar to that reported in the literature for the general population (20–50%). There was no significance between the prevalence of DP and a history of NAT (p > 0.1) or neglect (p > 0.1). Furthermore, there was no correlation between CVAI and characteristics of initial presentation or history of trauma for either NAT (p-values: 0.359 and 0.250, respectively) or neglect groups (p-values: 0.116 and 0.770, respectively). Conclusion While there are many limitations to this study, our results suggest that abused children are no more likely to have history of DP than the general population, and the degree of DP is not associated with severity of trauma history or initial presentation. We hope the results of this study promote future investigations for unique and subtle predictive factors of child abuse/neglect.

Denominator of Cranial Vault Asymmetry Index: Choosing Between Longer and Shorter Diagonal Lengths

“…A total of 30 original articles (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/SCS/E869) matched the inclusion criteria 3–32. There were 10 articles with LD denominators and 20 articles with SD denominators.…”

“…9 On the other hand, the absorbable plate and fixation system [the unsintered hydroxyapatite (uHA)/poly-L-lactic acid (uHA/ PLLA) plate system] have enough strength and stability to fix the segments in both maxillary and mandibular osteotomy such as Le Fort I osteotomy and SSRO. [10][11][12][13][14][15][16] The hybrid and bicortical absorbable plate fixation could show reliable stability with enough strength for class III mandibular setback and class II advancement surgery. 17 However, the comparison in the CT value of ramus bone between advancement surgery for class II and setback surgery for class III using the absorbable plate and screw has not been performed, although there was a study regarding the differences in the morphologic bone healing pattern.…”

Two-Dimensional Image-Based Screening Tool for Infants with Positional Cranial Deformities: A Machine Learning Approach

“… where diagonal A is greater than diagonal B. This index stratifies plagiocephaly into five severity levels; higher CVAI scores indicate severe asymmetry ( Table 1 B) [ 18 , 19 , 20 ].…”