Document Type
Article
Publication Date
11-4-2023
Abstract
BACKGROUND: Macrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly.
METHODS: We conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children's health system. Four neurosurgeons reviewed the images, determining cases to be a 'concern' if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of 'concern' in a multivariate model using conditional logistic regression.
RESULTS: In the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28-24.44), P < 0.001], prematurity [aOR 21.26, (95% CI: 3.76-120.21), P < 0.001], any delay [aOR 2.67, (95% CI: 1.13-6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22-2.37), P = 0.002].
CONCLUSIONS: Head imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention.
Recommended Citation
Rohde, Jessica F.; Campbell, Jeffrey; Barbera, Julie; Taylor, Elena; Ramachandra, Ashok; Gegg, Christopher; Scherer, Andrea; and Piatt, Joseph, "Clinical Factors Associated With Need for Neurosurgical Care in Young Children With Imaging for Macrocephaly: A Case Control Study" (2023). Department of Pediatrics Faculty Papers. Paper 142.
https://jdc.jefferson.edu/pedsfp/142
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
37925412
Language
English
Comments
This article is the author's final published version in BMC Pediatrics, Volume 23, 2023, Article number 555.
The published version is available at https://doi.org/10.1186/s12887-023-04379-2. Copyright © The Author(s) 2023.