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Effectiveness and Safety of Independent Pediatric Nurse Practitioners in Evaluating Plagiocephaly

Kuang, Anna A. M.D.; Bergquist, Curtis B.A.; Crupi, Lisa R.N., M.S., C.P.N.P.; Oliverio, Maureen R.N., B.S.N., C.P.N.P.; Selden, Nathan R. M.D., Ph.D.

Plastic and Reconstructive Surgery: August 2013 - Volume 132 - Issue 2 - p 414–418
doi: 10.1097/PRS.0b013e3182958a89
Pediatric/Craniofacial: Original Articles

Background: The American Academy of Pediatrics Back to Sleep program in 1992 dramatically increased the incidence of posterior plagiocephaly in infants. In 2000, the craniofacial disorders program at Oregon Health & Science University established a plagiocephaly screening clinic staffed by pediatric nurse practitioners.

Methods: Electronic medical records of patients seen in a single accredited craniofacial disorders clinic from 2005 to 2011 were reviewed retrospectively to identify patients screened independently by pediatric nurse practitioners for positional plagiocephaly versus synostosis.

Results: Over a 7-year period, 1228 patients were independently screened. Over half [638 patients (52 percent)] were followed through subsequent visits for craniofacial disorders without any direct surgeon input. Of these, 169 (26 percent) were treated with orthotic consultation for a molding helmet, 385 (60 percent) received a combination of counseling and/or physical therapy for torticollis, and 84 (13 percent) were lost to follow-up. No patient managed by pediatric nurse practitioners was identified to have cranial synostosis and no patient underwent early or delayed surgery. All returning patients [n = 554 (86 percent)] showed improvement in, or resolution of, their presenting deformity. The remaining 590 patients (48 percent) were referred by the pediatric nurse practitioner for surgical consultation. Computed tomographic imaging revealed synostosis in 121 patients.

Conclusions: Pediatric nurse practitioners accurately screened over half of patients referred to a high-volume craniofacial disorders program for positional plagiocephaly versus synostosis, without surgeon input. Based on available information, no synostosis diagnosis was overlooked using this approach. With specific training, pediatric nurse practitioners working in a craniofacial disorders program can safely and independently screen for positional versus synostotic plagiocephaly.


Portland, Ore.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Child Development and Rehabilitation Center, and Department of Neurological Surgery, Oregon Health & Science University.

Received for publication January 9, 2013; accepted February 22, 2013.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Nathan R. Selden, M.D., Ph.D. Department of Neurological Surgery Oregon Health & Science University Mail Code CH8N 3303 SW Bond Avenue Portland, Ore. 97239-3098

©2013American Society of Plastic Surgeons