Risk Factors for Delayed Diagnosis of Positional Plagiocephaly: A Review of 25,322 Patients.

Objective: This study identifies risk factors for late positional plagiocephaly (PP) diagnosis and impact on helmet therapy.

Design: We conducted a retrospective review of all patients diagnosed with PP over 10 years at five Southern California hospitals.

Setting: Patients diagnosed with PP at an included hospital.

Patients: 25,332 patients were diagnosed with PP over 10 years.

Interventions: Patients diagnosed with PP early (< = 6 months) and late (>6 months) were compared.

Main outcome measures: Cohorts were evaluated for demographics, gestational history, associated conditions, and hospitalizations through direct comparison, logistic regression, and correlation analyses. Rates of referrals and helmet orders were compared.

Results: Of patients reviewed, 4.8% (n  =  1216) were diagnosed late. On multivariate analysis, late diagnoses were more likely Hispanic or Black/African-American. Early gestational age, hydrocephalus, and VP shunt were more frequent in late diagnoses. Patients diagnosed late had longer NICU and overall hospital stays. Earlier gestational age, longer NICU or overall hospital stay correlated with later age at PP diagnosis. 8.9% of patients were referred for helmet therapy evaluation. Patients diagnosed late were 2.63 and 1.64 times as likely to be referred and require helmet therapy, respectively.

Conclusions: Patients who are Hispanic or Black/African-American, premature, have hydrocephalus, or VP shunt have higher rates of delayed PP diagnosis. Shorter gestational age or longer NICU or hospital stay correlates with later diagnosis, which increases helmet therapy requirements. Additional interventions are needed for at risk patients to routinely evaluate for and minimize the risk of developing PP.