Guidelines

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients with Positional Plagiocephaly: The Role of Imaging

Catherine Mazzola, Lissa C. Baird, David F. Bauer, Alexandra Beier, Susan Durham, Paul Klimo, Alexander Y. Lin, Catherine McClung-Smith, Laura Mitchell, Dimitrios Nikas, Mandeep S. Tamber, Rachana Tyagi, Ann Marie Flannery

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

BACKGROUND: No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. OBJECTIVE: The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis? METHODS: The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. CONCLUSION: Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter-2.

Original languageEnglish (US)
Pages (from-to)E625-E626
JournalNeurosurgery
Volume79
Issue number5
DOIs
StatePublished - Nov 1 2016

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Nonsynostotic Plagiocephaly
Plagiocephaly
Guidelines
Skull
Ultrasonography
Tomography
X-Rays
Medical Subject Headings
National Library of Medicine (U.S.)
Craniosynostoses
Manuscripts
Diagnostic Imaging
Libraries
Magnetic Resonance Imaging
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Guidelines : Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients with Positional Plagiocephaly: The Role of Imaging. / Mazzola, Catherine; Baird, Lissa C.; Bauer, David F.; Beier, Alexandra; Durham, Susan; Klimo, Paul; Lin, Alexander Y.; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S.; Tyagi, Rachana; Flannery, Ann Marie.

In: Neurosurgery, Vol. 79, No. 5, 01.11.2016, p. E625-E626.

Research output: Contribution to journalReview article

Mazzola, C, Baird, LC, Bauer, DF, Beier, A, Durham, S, Klimo, P, Lin, AY, McClung-Smith, C, Mitchell, L, Nikas, D, Tamber, MS, Tyagi, R & Flannery, AM 2016, 'Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients with Positional Plagiocephaly: The Role of Imaging', Neurosurgery, vol. 79, no. 5, pp. E625-E626. https://doi.org/10.1227/NEU.0000000000001427
Mazzola, Catherine ; Baird, Lissa C. ; Bauer, David F. ; Beier, Alexandra ; Durham, Susan ; Klimo, Paul ; Lin, Alexander Y. ; McClung-Smith, Catherine ; Mitchell, Laura ; Nikas, Dimitrios ; Tamber, Mandeep S. ; Tyagi, Rachana ; Flannery, Ann Marie. / Guidelines : Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients with Positional Plagiocephaly: The Role of Imaging. In: Neurosurgery. 2016 ; Vol. 79, No. 5. pp. E625-E626.
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abstract = "BACKGROUND: No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. OBJECTIVE: The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis? METHODS: The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. CONCLUSION: Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter-2.",
author = "Catherine Mazzola and Baird, {Lissa C.} and Bauer, {David F.} and Alexandra Beier and Susan Durham and Paul Klimo and Lin, {Alexander Y.} and Catherine McClung-Smith and Laura Mitchell and Dimitrios Nikas and Tamber, {Mandeep S.} and Rachana Tyagi and Flannery, {Ann Marie}",
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AU - Bauer, David F.

AU - Beier, Alexandra

AU - Durham, Susan

AU - Klimo, Paul

AU - Lin, Alexander Y.

AU - McClung-Smith, Catherine

AU - Mitchell, Laura

AU - Nikas, Dimitrios

AU - Tamber, Mandeep S.

AU - Tyagi, Rachana

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N2 - BACKGROUND: No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. OBJECTIVE: The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis? METHODS: The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. CONCLUSION: Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter-2.

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