Where are we headed? Diagnosing abnormal head shapes through virtual care visits

ABSTRACT

Background/Purpose: Since the beginning of the COVID-19 pandemic in early March, there has been a push to expand virtual patient care visits instead of in-person clinic visits. Studies have found that telemedicine can provide efficient triaging, reduction in emergency room visits, and conservation of health care resources and personnel. While virtual patient care has been implicated in providing similar outcomes to traditional face-to-face care, there are a lack of studies on the effectiveness of virtual care visits for patients with abnormal head shapes. This study aims to develop an understanding of whether physicians can accurately diagnose pediatric patients with craniosynostosis or deformational plagiocephaly via virtual care visits, and whether they can determine if affected patients will benefit from helmet correction or if surgical treatment is required. Methods/Description An IRB-approved retrospective chart analysis over a 4-month period (March 1, 2020, to June 30, 2020) was performed analyzing all pediatric patients (<18 years old) who underwent virtual care calls for diagnosis and treatment of abnormal head shape. Patients were referred to UTPhysicians Pediatric Surgery clinic for evaluation by a member of the Texas Cleft-Craniofacial Team (2 surgeons or 1 physician's assistant). Variables such as patient demographics, diagnosis, and need for confirmation were recorded. Results: Thirty-five patients were identified who fit our search criteria. Out of these patients, 11 (31.43%) cases were diagnosed with craniosynostosis and 22 (62.86%) cases were diagnosed with deformational plagiocephaly. Median age at virtual care evaluation was 14.10 months (IQR 5.729, 27.542) for patients diagnosed with craniosynostosis and 6.51 months (IQR 4.669, 7.068) for patients diagnosed with deformational plagiocephaly. All 11 (100%) patients diagnosed with craniosynostosis were referred for a confirmatory CT scan prior to undergoing surgical intervention and saw an alleviation in head shape postoperatively. Eighteen (81.82%) of patients diagnosed with deformational plagiocephaly were recommended to undergo conservative treatment and the remaining 4 (18.18%) were recommended for helmet therapy. Two cases (5.71%) were unable to be diagnosed virtually. These patients needed a follow-up visit in person to establish a diagnosis and plan of treatment. Conclusions: Virtual care visits are increasing in frequency and this includes consultations for abnormal head shapes. Our study underscores the feasibility of virtually diagnosing and recommending a plan for treatment in pediatric patients with abnormal head shapes, with only 5.71% requiring additional treatment or in-person visits to confirm the diagnosis. This information can be implemented to further our knowledge on the accuracy of diagnosis and treatment options for patients with craniosynostosis and deformational plagiocephaly. Further analyses are needed to quantify the financial and patient-reported outcomes of virtual care visits for these patients.