Journal article
Standardized Haller and Asymmetry Index Combined for a More Accurate Assessment of Pectus Excavatum.
- Sesia SB Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: sergio.sesia@gmx.net.
- Heitzelmann M Department of Pediatrics, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany.
- Schaedelin S Clinical Trial Unit, University of Basel, Basel, Switzerland.
- Magerkurth O Department of Radiology, Kantonsspital Baden, Baden, Switzerland.
- Kocher GJ Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.
- Schmid RA Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.
- Haecker FM Department of Pediatric Surgery, Stiftung Ostschweizer Kinderspital, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
- 2018-10-03
Published in:
- The Annals of thoracic surgery. - 2019
Adolescent
Child
Female
Funnel Chest
Humans
Imaging, Three-Dimensional
Male
ROC Curve
Retrospective Studies
Severity of Illness Index
Thoracic Wall
Thoracoplasty
Tomography, X-Ray Computed
Young Adult
English
BACKGROUND
The measurement of the Haller index (HI) is not standardized, and HI does not consider the asymmetry of pectus excavatum. The aim of this study was to determine the most appropriate level for measuring the HI and to introduce the asymmetry index (AI) in order to respect the aspect of asymmetry.
METHODS
Preoperative computer tomography scans of 43 patients with pectus excavatum were retrospectively analyzed by measuring both the HI and the AI at 3 different levels: (I) sternomanubrial junction; (II) caudal end of corpus sterni; and (III) tip of the xiphoid. The control group comprised 33 patients without chest wall deformity and a HI < 3.25. For each patient HI and AI were calculated according to a standardized protocol. A McNemar test was used for statistical analyses.
RESULTS
The sensitivity of the HI was highest when measured at level II (p < 0.388), and the AI exhibited the highest sensitivity at level I. When combining both indices, the sensitivity of assessing pectus excavatum significantly increased compared with the use of HI at level II alone (p < 0.002).
CONCLUSIONS
The measurement of the HI at level II represents the most valid standardized parameter for assessment of the severity of pectus excavatum. Asymmetry, on the other hand, is best assessed by the AI measured at level I. The combination of the standardized HI and AI not only provides a much more accurate description of pectus excavatum, but also improves the comparability of pectus excavatum patients in general.
The measurement of the Haller index (HI) is not standardized, and HI does not consider the asymmetry of pectus excavatum. The aim of this study was to determine the most appropriate level for measuring the HI and to introduce the asymmetry index (AI) in order to respect the aspect of asymmetry.
METHODS
Preoperative computer tomography scans of 43 patients with pectus excavatum were retrospectively analyzed by measuring both the HI and the AI at 3 different levels: (I) sternomanubrial junction; (II) caudal end of corpus sterni; and (III) tip of the xiphoid. The control group comprised 33 patients without chest wall deformity and a HI < 3.25. For each patient HI and AI were calculated according to a standardized protocol. A McNemar test was used for statistical analyses.
RESULTS
The sensitivity of the HI was highest when measured at level II (p < 0.388), and the AI exhibited the highest sensitivity at level I. When combining both indices, the sensitivity of assessing pectus excavatum significantly increased compared with the use of HI at level II alone (p < 0.002).
CONCLUSIONS
The measurement of the HI at level II represents the most valid standardized parameter for assessment of the severity of pectus excavatum. Asymmetry, on the other hand, is best assessed by the AI measured at level I. The combination of the standardized HI and AI not only provides a much more accurate description of pectus excavatum, but also improves the comparability of pectus excavatum patients in general.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.athoracsur.2018.07.086
- PMID 30278167
- Persistent URL
- https://sonar.ch/global/documents/166976
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