Success and duration of dynamic bracing for pectus carinatum: A four-year prospective study.
BACKGROUND
This study sought to establish factors that can prognosticate outcomes of bracing for pectus carinatum (PC).


METHODS
Prospective data were collected on all patients enrolled in a dynamic bracing protocol from July 2011 to July 2015. Pressure of correction (POC) was measured at initiation of treatment, and pressure of treatment (POT) was measured pre- and post-adjustment at every follow-up visit. Univariate and Cox regression analysis tested the following possible determinants of success and bracing duration: age, sex, symmetry, POC, and POT drop during the first two follow-up visits.


RESULTS
Of 114 patients, 64 (56%) succeeded, 33 (29%) were still in active bracing, and 17 (15%) failed or were lost to follow-up. In successful patients, active and maintenance bracing was 5.66±3.81 and 8.80±3.94months, respectively. Asymmetry and older age were significantly associated with failure. Multivariable Cox proportional hazard analysis of time-to-maintenance showed that asymmetry (p=0.01) and smaller first drop in POT (p=0.02) were associated with longer time to reach maintenance.


CONCLUSIONS
Pressure of correction does not predict failure of bracing, but older age, asymmetry, and smaller first drop in pressure of treatment are associated with failure and longer bracing duration.


METHODS
Prospective Study/Level of Evidence IV.
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada. Electronic address: Sherif.Emil@McGill.ca.
Sherif
S
Emil
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Marika
M
Sévigny
Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Kathleen
K
Montpetit
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Robert
R
Baird
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Jean-Martin
JM
Laberge
Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Jade
J
Goyette
Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Ian
I
Finlay
Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Guylaine
G
Courchesne
D000293:Adolescent; D001915:Braces; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D066166:Pectus Carinatum / Q000628:therapy*; D011312:Pressure; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Bracing; Dynamic; Outcomes; Pectus carinatum; Pressure