Variable co-diagnosis of plagiocephaly and torticollis in Texas health care facilities

Diagnosis of positional plagiocephaly has increased as babies have been put to sleep supine. The literature varies in reported co-incidence of sternocleidomastoid torticollis, as well as in definition of torticollis as a defect. Statewide data from the Texas Birth Defects registry was analyzed for the diagnosis of plagiocephaly with or without co-diagnosis of torticollis. There were 172 facilities with at least 1 diagnosis of plagiocephaly. Of these, 18 facilities had recorded >20 cases and 3 facilities had recorded >150 cases. In the 18 facilities, percentage of plagiocephaly/torticollis co-diagnosis ranged from 5% to 67%. Two facilities specialize in orthopedic or neurologic problems, but the rest are general pediatric facilities. The three facilities with the most cases showed co-diagnosis of 10% (16 of 159 cases), 29% (108 of 376 cases), and 54% (122 of 228 cases). It is noted that the three largest facilities use different professionals and different medical specialists in evaluation of cases. These data suggest that the wide range in torticollis diagnosis is less likely to reflect true patient variability than an inconsistently applied definition of the defect. Other factors that may play a role are diagnosis by non-MD medical professionals, involvement of different MD specialists in different facilities and diagnosis-dependent but variable insurance reimbursement.