Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida.
Division of Pediatric Surgery, Emory Children's and Children's Healthcare of Atlanta, Atlanta, Georgia.
J Surg Res. 2024 Oct;302:484-489. doi: 10.1016/j.jss.2024.07.064. Epub 2024 Aug 21.
Patients with pectus excavatum (PE) often undergo cross-sectional imaging (CSI) to quantify severity for insurance authorization before surgical repair. The modified percent depth (MPD), an external caliper-based metric, was previously validated to be similar to the pectus index and correction index. This study explored family perceptions of CSI and MPD with respect to value and costs.
This is a cross-sectional survey study including families of patients enrolled in an ongoing prospective multicenter study evaluating the use of MPD as an alternative to CSI for quantifying PE severity. Families of PE patients who underwent both MPD and CSI completed a survey to determine their perceptions of MPD and costs of CSI. Responses were described and associations were evaluated using chi squared, Wilcoxon rank-sum test and logistic regression as appropriate. Statistical significance was set to 0.05.
There were 136 surveys completed for a response rate of 88%. Respondents were confident in MPD (86%) and confident in its similarity to CSI (76%). Families of females were less confident in the measurements than males (55% versus 80%, P = 0.02; odds ratio 0.30 (0.11, 0.83). Obtaining CSI required time off work/school in 90% and a copay in 60%. Nearly half (49%) of respondents reported CSI was a time/financial hardship. Increasing copay led to decreased reassurance in CSI (55%: copay > $100 versus 77%: lower copay/75%: no copay; P = 0.04).
From the family perspective, MPD is valuable in assessing the severity of PE. Obtaining CSI was financially burdensome, particularly for those with higher copays. MPD measurements provide high value at low cost in assessing the severity of PE.
患有漏斗胸（PE）的患者通常在接受手术修复前，需要进行横断面成像（CSI）来量化严重程度，以获得保险授权。基于外部卡尺的改良深度百分比（MPD）之前已被验证与胸指数和矫正指数相似。本研究探讨了家庭对 CSI 和 MPD 的看法，包括其价值和成本。
这是一项横断面调查研究，包括参与正在进行的多中心前瞻性研究的患者的家庭，该研究评估了使用 MPD 替代 CSI 来量化 PE 严重程度。接受 MPD 和 CSI 检查的 PE 患者的家属完成了一项调查，以确定他们对 MPD 的看法以及 CSI 的成本。使用卡方检验、Wilcoxon 秩和检验和逻辑回归进行描述和关联评估，适当情况下使用 P 值<0.05 作为统计学意义的标准。
共有 136 份调查问卷完成，应答率为 88%。受访者对 MPD 有信心（86%），对其与 CSI 的相似性有信心（76%）。女性家属对测量结果的信心低于男性家属（55%对 80%，P=0.02；优势比 0.30（0.11，0.83））。获得 CSI 需要 90%的人请假/停学，60%的人需要支付共付额。近一半（49%）的受访者报告 CSI 是时间/经济上的困难。共付额增加导致对 CSI 的信心降低（55%：共付额>100 美元对 77%：较低共付额/75%：无共付额；P=0.04）。
从家庭的角度来看，MPD 对评估 PE 的严重程度很有价值。获得 CSI 会带来经济负担，尤其是对共付额较高的患者而言。MPD 测量在评估 PE 严重程度方面具有高价值、低成本的特点。
