An Updated Prediction Model for the Maximum Expected Treatment Time with a Cranial Remolding Orthosis

ABSTRACT Introduction Caregivers of infants with deformational head shapes frequently inquire about treatment time estimations. In 2022, a predictive model (V1) was tested and a new model proposed (V2), which estimates maximum expected treatment duration with a cranial remolding orthosis (CRO). This retrospective study assesses the accuracy of V2 and proposes a third version (V3) of the model. Methods Subjects with deformational head shapes who were treated with a CRO between 3 and 18 months postpartum were included based on initial cranial measurements. Infants were excluded if they had a significant comorbidities, missing data, or had documented noncompliance. Separate datasets were used to derive and validate V2. Results Derivation of V2 included 1,460 subjects and a separate 294 subjects were used for validation. 81.44% of the plagiocephalic infants, 63.39% of the brachycephalic infants, and 76.77% of the asymmetrical brachycephalic infants completed treatment on or before the predicted timeframe. Predictions tended to overshoot compared to the actual treatment time but showed less variance in the standard deviations than V1. Conclusions V2 had improved accuracy across all studied head shapes. A slight overestimation in the predicted treatment time may lead to improved caregiver satisfaction associated with a shorter than expected treatment duration. Overshooting of the model is possibly due to demographic differences in the training data and validation data. Decreased variance in standard deviation of the revised model is attributed to the increased subject pool used in the derivation, thus creating increased precision of the model. Clinical Relevance Currently, no clinically accepted predictive model exists for an accurate estimation of CRO treatment duration, so providers primarily rely on clinical experience. An accurate model may help clinicians set realistic timeframes leading to increased treatment satisfaction from enhanced communication.