Comparison of perceptions and treatment practices between neurosurgeons and plastic surgeons for infants with deformational plagiocephaly

Clinical article

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Object

Deformational plagiocephaly (DP) is the leading cause of head shape abnormalities in infants. Treatment options include conservative measures and cranial molding. Pediatric neurosurgeons and craniofacial plastic surgeons have yet to agree on an ideal therapy, and no definable standards exist for initiating treatment with helmets. Furthermore, there may be differences between specialties in their perceptions of DP severity and need for helmet therapy.

Methods

Requests to participate in a web-based questionnaire were sent to diplomates of the American Board of Pediatric Neurological Surgery and US and Canadian members of the Pediatric Joint Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and the American Cleft Palate–Craniofacial Association. Questions focused on educational background; practice setting; volume of DP patients; preferences for evaluation, treatment, follow-up; and incentives or deterrents to treat with helmet therapy. Six examples of varying degrees of DP were presented to delineate treatment preferences.

Results

Requests were sent to 302 neurosurgeons and 470 plastic surgeons, and responses were received from 71 neurosurgeons (24%) and 64 plastic surgeons (14%). The following responses represented the greatest variations between specialties: 1) 8% of neurosurgeons and 26% of plastic surgeons strongly agreed with the statement that helmet therapy is more beneficial than conservative therapy (p < 0.01); and 2) 25% of neurosurgeons and 58% of plastic surgeons would treat moderate to severe DP with helmets (p < 0.01).

Conclusions

Survey responses suggest that neurosurgeons are less likely to prescribe helmet therapy for DP than plastic surgeons. Parents of children with DP are faced with a costly treatment decision that may be influenced more strongly by referral and physician bias than medical evidence.

Abbreviation used in this paper: DP = deformational plagiocephaly.

Article Information

Address correspondence to: Amy Lee, M.D., Washington University School of Medicine, Department of Neurosurgery, Campus Box 8057, 660 South Euclid Avenue, St. Louis, Missouri 63110. email: leeam@nsurg.wustl.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graph showing the training and practice backgrounds of respondents. A+P = academic and private; NS = neurosurgeon; PS = plastic surgeon.

  • View in gallery

    Box and whiskers plots showing the 25th and 75th percentiles (box) and range (whiskers) of the percentage of patients that actually receive helmet therapy by specialty.

  • View in gallery

    Bar graph showing responses to the statement: “Helmet therapy is more beneficial than conservative management for deformational plagiocephaly.”

  • View in gallery

    Overhead-view computer-generated images of varying degrees of DP (mild, moderate, severe) and bar graphs showing physicians' responses to being asked whether they would treat these infants with a helmet. Avg = average.

References

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