Degree of Agreement Between Different Classification Systems for Severity Levels of Positional Plagiocephaly

Aim To assess the agreement between severity level classifications of plagiocephaly using measurement of the difference between transcranial diagonals (DTD) and the Cranial Vault Asymmetry Index (CVAi), based on different references found in the literature. Method Observational study conducted with 50 babies with a possible diagnosis of plagiocephaly. Diagnosis and cranial measurements were obtained through 3D cranial scanning. The cranial measurements selected for the study were DTD (in cm) and CVAi (in %), which determined, according to different classification systems, the severity level of the asymmetry as absent, mild, moderate, or severe. Three different classification references using DTD and four using CVAi were applied to determine severity, and agreement between classifications were analyzed using the κ index. Results and Interpretation Agreement between the classifications using DTD and CVAi measurements ranged from weak to moderate across all references found in the literature. All analyses were statistically significant. Findings suggest that there may be conflicts and discrepancies in classifying the deformity as mild, moderate, or severe, which can lead to different clinical treatment decisions.