title: Value and reliability of anthropometric measurements of cranial deformity in early childhood.
abstract: OBJECTIVE
  Since the "back to sleep" campaign initiated by the American Pediatric Society in 1992, an increasing incidence of positional cranial deformity in early infancy has been widely observed. Anthropometric caliper measurements present the most practical tool for diagnosis and decision making although their value is being controversially discussed in literature.
  
  
  METHODS
  Our study included 30 randomly chosen infants who had been diagnosed with plagiocephaly, brachycephaly, or a combination of both conditions. The 10 patients in each group were then measured anthropometrically by three examiners. The following parameters were measured six times in a standard manner and with a standard head position by each examiner: circumference, length, width, and oblique distance from the fronto-temporal area (ft) to the lambdoid suture on each side of the head (ld). Inter- and intra-observer variabilities for every value were statistically evaluated by a variance components estimation procedure.
  
  
  RESULTS
  Both inter- and intra-observer agreement had very low variability. Overall, mean inter-observer variability was lower than 0.182mm(2), and mean intra-observer variability was lower than 1.131mm(2). Altogether, interobserver variability as well as intraobserver variability had a maximum of about 2 mm measurement variance.
  
  
  CONCLUSIONS
  Standardized measurements are highly reproducible to quantify early childhood head deformity. Standard head position is indispensable for reliable measurement. Repeatability of anthropometric measurements is essential to define diagnoses and severity codes and to develop treatment concepts.
authors.affiliation: Department for Maxillofacial Surgery, Plastic Surgery, Klinikstraße 29, 35390 Giessen, Germany. jan-falco.wilbrand@chiru.med.uni-giessen.de
authors.forename: Jan-Falco
authors.initials: JF
authors.lastname: Wilbrand
authors.forename: Martina
authors.initials: M
authors.lastname: Wilbrand
authors.forename: Joern
authors.initials: J
authors.lastname: Pons-Kuehnemann
authors.forename: Joerg-Christoph
authors.initials: JC
authors.lastname: Blecher
authors.forename: Petros
authors.initials: P
authors.lastname: Christophis
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Howaldt
authors.forename: Heidrun
authors.initials: H
authors.lastname: Schaaf
mesh_terms: D000886:Anthropometry; D002508:Cephalometry / Q000706:statistics & numerical data*; D003393:Cranial Sutures / Q000473:pathology; D019465:Craniofacial Abnormalities / Q000175:diagnosis*; D003398:Craniosynostoses / Q000175:diagnosis; D003657:Decision Making; D005624:Frontal Bone / Q000473:pathology; D006801:Humans; D007223:Infant; D015588:Observer Variation; D009777:Occipital Bone / Q000473:pathology; D010294:Parietal Bone / Q000473:pathology; D059041:Plagiocephaly / Q000175:diagnosis; D049068:Plagiocephaly, Nonsynostotic / Q000175:diagnosis; D012886:Skull / Q000473:pathology; D013701:Temporal Bone / Q000473:pathology