Plagiocephaly Severity Scale to Aid in Clinical Treatment Recommendations

Abstract

Studies have attempted to categorize infant cranial asymmetry in a variety of ways using both observational and quantitative techniques, but none have created a clinical tool that can serve as a treatment guide based on clinical outcomes. In 2006, a research team from Children's Healthcare of Atlanta published the results of a prospective analysis of 224 patients with cranial asymmetries and their treatment outcomes. As a continuation of the previous work, the researchers have identified a plagiocephaly severity scale based on those outcomes to assist medical professionals who treat patients with cranial abnormalities. Our hypothesis is to validate the proposed severity scale that categorizes the clinical presentation and severity of plagiocephaly.Of the 224 patients enrolled, 207 patients were placed in an experimental group and 17 patients who refused treatment were placed in a control group. Digital head shape data were collected. Cross-correlation matrices were computed across variables and regression models resulted in the identification of 5 meaningful variables. A 5-level clinical classification scale was created. Five 1 × 5 analyses of variance were computed to compare each classification level.Four of the 5 analyses of variance identified significant overall effects for classification. A model was developed from the empirical data and the model was tested for accuracy, resulting in 12.1% overall error. The model was validated for both experimental and control groups.The results show that the severity scale is a meaningful outcome-based scale that assists clinicians in developing a treatment plan for treating plagiocephaly. The scale has been validated across a large heterogeneous study sample.

Delayed Motor Development and Infant Obesity as Risk Factors for Severe Deformational Plagiocephaly: A Matched Case–Control Study

“…Deformational plagiocephaly was diagnosed when the CVA was >10 mm and the CVAI was >3.5% (1,8). The severity of DP was categorized as mild, moderate, or severe based on the validated Children's Healthcare of Atlanta (CHOA) scale (28). Mild DP was defined as a CVAI between 3.5 and 6.25, moderate was defined as a CVAI between 6.25 and 8.75, and severe was defined as a CVAI >8.75 (28).…”

Significant Factors in Cranial Remolding Orthotic Treatment of Asymmetrical Brachycephaly

“…Subjects were grouped according to severity. Although the CHOA scale [7] is used to describe plagiocephalic head shapes, no uniform scale is accepted for brachycephalic head shapes, and no scale exists for a combination of the two deformations, as seen in asymmetrical brachycephaly. Therefore, for this study, a brachycephalic scale was created based on a variety of published scales in the literature [11,[27][28][29][30][31], combined with the authors' clinical expertise.…”

“…Repositioning therapy usually involves keeping an infant's head in a desired position. Parents are also advised to increase supervised tummy time and decrease time in car seats and rockers [7]. Depending on the type of deformational head shape and presence of torticollis (a congenital muscular dystrophy involving shortening of the sternocleidomastoid often associated with plagiocephaly [1]), repositioning can be difficult.…”

“…When using CVA, a difference of up to 3mm is usually considered within normal limits, a difference between 3mm and 12mm is mild to moderate, and severe is any difference greater than 12mm; however, these scales have not been validated in the literature [2,32]. For this study, CVAI was chosen for cranial measurement reporting due to the availability of the validated Children's Healthcare of Atlanta (CHOA) scale [7]. The CHOA scale defines plagiocephaly as mild when CVAI is 3.5-6.25, moderate when CVAI is 6.25-8.75, severe as a CVAI 8.75-11, and very severe as greater than 11 [7].…”

“…For this study, CVAI was chosen for cranial measurement reporting due to the availability of the validated Children's Healthcare of Atlanta (CHOA) scale [7]. The CHOA scale defines plagiocephaly as mild when CVAI is 3.5-6.25, moderate when CVAI is 6.25-8.75, severe as a CVAI 8.75-11, and very severe as greater than 11 [7]. Wilbrand et al (2017) published a table of normative values of circumference, width, length, CVA, CI, and CVAI for infants from 0 to 24 months which can be used to help develop standards for defining plagiocephaly and brachycephaly [10].…”