Original ArticlesPlagiocephaly Severity Scale to Aid in Clinical Treatment RecommendationsHolowka, Mark A. MSPO, CPO*; Reisner, Andrew MD*,†; Giavedoni, Brian MBA*; Lombardo, Janet R. MBA, CPO*; Coulter, Colleen DPT, PhD*,‡Author Information *Children's Healthcare of Atlanta †Departments of Pediatrics and Neurosurgery ‡Department of Physical Therapy, Emory University School of Medicine, Atlanta, GA. Address correspondence and reprint requests to Mark A. Holowka, MSPO, CPO, Children's Healthcare of Atlanta, 5445 Meridian Mark Road, Suite 200, Atlanta, GA 30342, E-mail: firstname.lastname@example.org Received 5 July, 2016 Accepted 28 November, 2016 The authors report no conflicts of interest. Journal of Craniofacial Surgery: May 2017 - Volume 28 - Issue 3 - p 717-722 doi: 10.1097/SCS.0000000000003520 Buy Metrics Abstract Studies have attempted to categorize infant cranial asymmetry in a variety of ways using both observational and quantitative techniques, but none have created a clinical tool that can serve as a treatment guide based on clinical outcomes. In 2006, a research team from Children's Healthcare of Atlanta published the results of a prospective analysis of 224 patients with cranial asymmetries and their treatment outcomes. As a continuation of the previous work, the researchers have identified a plagiocephaly severity scale based on those outcomes to assist medical professionals who treat patients with cranial abnormalities. Our hypothesis is to validate the proposed severity scale that categorizes the clinical presentation and severity of plagiocephaly. Of the 224 patients enrolled, 207 patients were placed in an experimental group and 17 patients who refused treatment were placed in a control group. Digital head shape data were collected. Cross-correlation matrices were computed across variables and regression models resulted in the identification of 5 meaningful variables. A 5-level clinical classification scale was created. Five 1 × 5 analyses of variance were computed to compare each classification level. Four of the 5 analyses of variance identified significant overall effects for classification. A model was developed from the empirical data and the model was tested for accuracy, resulting in 12.1% overall error. The model was validated for both experimental and control groups. The results show that the severity scale is a meaningful outcome-based scale that assists clinicians in developing a treatment plan for treating plagiocephaly. The scale has been validated across a large heterogeneous study sample. © 2017 by Mutaz B. Habal, MD.