Diagnostic yield of routine skull radiographs in infants with deformational plagiocephaly

Min Jeong Cho, Loa L. Borchert, Alex A. Kane

Research output: Contribution to journalReview article

Abstract

Objective: Differentiating synostotic and nonsynostotic plagiocephaly can be challenging, and many providers routinely obtain screening skull radiographs when evaluating an infant with plagiocephaly. However, the diagnostic yield of radiographs has not been studied in this clinical setting. Design: This study was a retrospective chart review. Setting: The study took place in a tertiary care center. Patients: We retrospectively reviewed the records of all patients referred to Children's Medical Center (Dallas, TX) between the years 2010 to 2012 with a diagnosis of plagiocephaly. After an initial evaluation, skull radiographs were obtained to rule out craniosynostosis. We reviewed clinical and demographic data and radiographic findings to determine the diagnostic yield of routine screening radiographs in infants presenting with plagiocephaly. Results: There were 1219 patients in total, and 1213 of these patients received screening four view conventional skull radiographs. Six had computed tomography without prior radiographs. Of the patients inthe skull radiograph group, 24%(289 of 1213) had abnormal radiographic findings, and 7.6% of this group (22 of 289) had findings that were indicative of craniosynostosis. Of these 22 patients, 12 obtained follow-up studies, and only three patients (0.2% of skull group) had true craniosynostosis. In comparison, 50% (three of six) in the group of patients who underwent computed tomography without prior conventional screening radiographs had true craniosynostosis. Conclusions: Routine screening skull radiographs have a low diagnostic yield in differentiating between synostotic and nonsynostotic plagiocephaly in patients presenting to a tertiary care deformational plagiocephaly clinic. Considering the costs and radiation exposure, the benefit of the routine use of skull radiographs in patients with deformational plagiocephaly is questionable.

Original languageEnglish (US)
Pages (from-to)497-501
Number of pages5
JournalCleft Palate-Craniofacial Journal
Volume54
Issue number5
DOIs
StatePublished - Sep 1 2017

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Nonsynostotic Plagiocephaly
Skull
Craniosynostoses
Plagiocephaly
Tomography
Tertiary Healthcare
Tertiary Care Centers

Keywords

  • Craniosynostosis
  • Deformational plagiocephaly
  • Radiation risks
  • Skull radiographs

ASJC Scopus subject areas

  • Oral Surgery
  • Otorhinolaryngology

Cite this

Diagnostic yield of routine skull radiographs in infants with deformational plagiocephaly. / Cho, Min Jeong; Borchert, Loa L.; Kane, Alex A.

In: Cleft Palate-Craniofacial Journal, Vol. 54, No. 5, 01.09.2017, p. 497-501.

Research output: Contribution to journalReview article

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title = "Diagnostic yield of routine skull radiographs in infants with deformational plagiocephaly",
abstract = "Objective: Differentiating synostotic and nonsynostotic plagiocephaly can be challenging, and many providers routinely obtain screening skull radiographs when evaluating an infant with plagiocephaly. However, the diagnostic yield of radiographs has not been studied in this clinical setting. Design: This study was a retrospective chart review. Setting: The study took place in a tertiary care center. Patients: We retrospectively reviewed the records of all patients referred to Children's Medical Center (Dallas, TX) between the years 2010 to 2012 with a diagnosis of plagiocephaly. After an initial evaluation, skull radiographs were obtained to rule out craniosynostosis. We reviewed clinical and demographic data and radiographic findings to determine the diagnostic yield of routine screening radiographs in infants presenting with plagiocephaly. Results: There were 1219 patients in total, and 1213 of these patients received screening four view conventional skull radiographs. Six had computed tomography without prior radiographs. Of the patients inthe skull radiograph group, 24{\%}(289 of 1213) had abnormal radiographic findings, and 7.6{\%} of this group (22 of 289) had findings that were indicative of craniosynostosis. Of these 22 patients, 12 obtained follow-up studies, and only three patients (0.2{\%} of skull group) had true craniosynostosis. In comparison, 50{\%} (three of six) in the group of patients who underwent computed tomography without prior conventional screening radiographs had true craniosynostosis. Conclusions: Routine screening skull radiographs have a low diagnostic yield in differentiating between synostotic and nonsynostotic plagiocephaly in patients presenting to a tertiary care deformational plagiocephaly clinic. Considering the costs and radiation exposure, the benefit of the routine use of skull radiographs in patients with deformational plagiocephaly is questionable.",
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N2 - Objective: Differentiating synostotic and nonsynostotic plagiocephaly can be challenging, and many providers routinely obtain screening skull radiographs when evaluating an infant with plagiocephaly. However, the diagnostic yield of radiographs has not been studied in this clinical setting. Design: This study was a retrospective chart review. Setting: The study took place in a tertiary care center. Patients: We retrospectively reviewed the records of all patients referred to Children's Medical Center (Dallas, TX) between the years 2010 to 2012 with a diagnosis of plagiocephaly. After an initial evaluation, skull radiographs were obtained to rule out craniosynostosis. We reviewed clinical and demographic data and radiographic findings to determine the diagnostic yield of routine screening radiographs in infants presenting with plagiocephaly. Results: There were 1219 patients in total, and 1213 of these patients received screening four view conventional skull radiographs. Six had computed tomography without prior radiographs. Of the patients inthe skull radiograph group, 24%(289 of 1213) had abnormal radiographic findings, and 7.6% of this group (22 of 289) had findings that were indicative of craniosynostosis. Of these 22 patients, 12 obtained follow-up studies, and only three patients (0.2% of skull group) had true craniosynostosis. In comparison, 50% (three of six) in the group of patients who underwent computed tomography without prior conventional screening radiographs had true craniosynostosis. Conclusions: Routine screening skull radiographs have a low diagnostic yield in differentiating between synostotic and nonsynostotic plagiocephaly in patients presenting to a tertiary care deformational plagiocephaly clinic. Considering the costs and radiation exposure, the benefit of the routine use of skull radiographs in patients with deformational plagiocephaly is questionable.

AB - Objective: Differentiating synostotic and nonsynostotic plagiocephaly can be challenging, and many providers routinely obtain screening skull radiographs when evaluating an infant with plagiocephaly. However, the diagnostic yield of radiographs has not been studied in this clinical setting. Design: This study was a retrospective chart review. Setting: The study took place in a tertiary care center. Patients: We retrospectively reviewed the records of all patients referred to Children's Medical Center (Dallas, TX) between the years 2010 to 2012 with a diagnosis of plagiocephaly. After an initial evaluation, skull radiographs were obtained to rule out craniosynostosis. We reviewed clinical and demographic data and radiographic findings to determine the diagnostic yield of routine screening radiographs in infants presenting with plagiocephaly. Results: There were 1219 patients in total, and 1213 of these patients received screening four view conventional skull radiographs. Six had computed tomography without prior radiographs. Of the patients inthe skull radiograph group, 24%(289 of 1213) had abnormal radiographic findings, and 7.6% of this group (22 of 289) had findings that were indicative of craniosynostosis. Of these 22 patients, 12 obtained follow-up studies, and only three patients (0.2% of skull group) had true craniosynostosis. In comparison, 50% (three of six) in the group of patients who underwent computed tomography without prior conventional screening radiographs had true craniosynostosis. Conclusions: Routine screening skull radiographs have a low diagnostic yield in differentiating between synostotic and nonsynostotic plagiocephaly in patients presenting to a tertiary care deformational plagiocephaly clinic. Considering the costs and radiation exposure, the benefit of the routine use of skull radiographs in patients with deformational plagiocephaly is questionable.

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KW - Deformational plagiocephaly

KW - Radiation risks

KW - Skull radiographs

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