Pivar Suzanne J, Scheuerle Angela
Tesserae Genetics, Dallas, Texas 75230, USA.
J Craniofac Surg. 2006 Mar;17(2):236-40. doi: 10.1097/00001665-200603000-00006.
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.
随着让婴儿仰卧睡觉，扁头畸形的诊断率有所上升。关于胸锁乳突肌斜颈的报告共现率以及斜颈作为一种缺陷的定义，文献中的说法各不相同。分析了得克萨斯州出生缺陷登记处的全州数据，以了解有无斜颈共诊断的扁头畸形诊断情况。有172家机构至少有1例扁头畸形诊断记录。其中，18家机构记录了超过20例病例，3家机构记录了超过150例病例。在这18家机构中，扁头畸形/斜颈共诊断的百分比在5%至67%之间。两家机构专门处理骨科或神经问题，其余为普通儿科机构。病例数最多的三家机构的共诊断率分别为10%（159例中的16例）、29%（376例中的108例）和54%（228例中的122例）。值得注意的是，最大的三家机构在病例评估中使用不同的专业人员和不同的医学专家。这些数据表明，斜颈诊断的广泛差异更有可能反映的是缺陷定义应用不一致，而非真正的患者差异。可能起作用的其他因素包括非医学专业人员进行诊断、不同机构中不同医学专家的参与以及依赖诊断但各不相同的保险报销情况。
