Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. This systematic review of 22 studies suggests standardized head shape measurements and photography techniques demonstrate high reliability and similar diagnostic utility to gold standard modalities in the evaluation of deformational plagiocephaly.

2. Improvements in automated diagnostic algorithms and smartphone-based imaging techniques offer a promising avenue for rapid, objective, and accurate in-office assessment of infant plagiocephaly.

Evidence Rating Level: 2 (Good)

Study Rundown:

Deformational plagiocephaly is a common condition in infants that may lead to undesirable cosmetic and developmental outcomes. In the outpatient setting, evaluation consists of physical exam and measurement of head circumference, which can be non-specific and provide a challenge in assessing the need for referral to physical therapy or neurosurgery. This systematic review evaluated the last three decades of advancement in diagnostic modalities for assessing cranial deformities in infants. Five modalities of objectively analyzing cranial asymmetry were identified in 22 studies: 1) anthropometry, the standardized measurement of the skull with calipers, 2) plagiocephalometry (PCM), the use of a thermoplastic band that molds to the child’s head allowing anthropomorphic measurements, 3) single image digital photography of the infant’s skull from a top-down perspective, 4) 3D photogrammetry utilizing a set of still images from either a single smartphone or a staged multicamera setup, and 5) laser scanning to create a 3D model of the infant’s head. Though they often used different indices for estimating cranial asymmetry, these studies demonstrated high inter- and intra-rater reliability, and had comparable diagnostic utility to gold-standard CT imaging and/or expert evaluations. Comparison of the modalities was not possible due to the heterogeneity of measures, validation methods, and reference standards across the studies. The high reliability and strength of the individual diagnostic validation studies, however, support the review’s assertion that accessible quantitative methods of monitoring deformational plagiocephaly are already available for outpatient pediatricians.

In-Depth [systematic review]:

This systematic review included 22 articles published between the years 2005 and 2021 that investigated the use of non-radiographic and novel modalities to diagnose plagiocephaly in young children. 19/22 of the studies were found to be at low risk for bias utilizing the Quality Assessment of Diagnostic Accuracy Studies. If available, data on accuracy, time-to-diagnosis, reliability, and outcomes were pulled from each study by two independent reviewers. Five unique modalities – anthropometry, plagiocephalometry, digital photography, 3D photogrammetry, and 3D laser scanning – were identified. Major themes that emerged from the review included the method of head shape analysis, the integration of smartphone technology in outpatient digital imaging techniques, and the rapid advance of machine-learning and automated diagnosis in improving assessment of deformational plagiocephaly.

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