title: A less intensive bracing protocol for pectus carinatum.
abstract: OBJECTIVE
  Despite the widespread use of bracing to correct Pectus carinatum (PC) there is no consensus in the number of hours per day patients are instructed to wear the brace. In our practice, we use a less rigorous protocol of 8-12h/day. We sought to evaluate our results and those in the literature to determine whether more intensive usage is necessary.
  
  
  METHODS
  We reviewed the outcomes of patients with PC treated at our institution between 2012 and 2015. We searched MEDLINE, EMBASE and Web of Science for studies describing the use of bracing to correct PC.
  
  
  RESULTS
  Seventy-five patients presented with PC at our institution. Among those who were offered bracing and had adequate follow-up (n=32), the success rate (full correction or improvement) was 90.6%. The compliance rate was 93.8%. Fifteen studies met our inclusion criteria. Our pooled data combining our results with those of other published data showed that less intensive brace usage (<12h/day), when compared to more intensive usage (≥12h/day), is associated with higher patient compliance (89.6% vs. 81.1%) with a similar time to correction (7.3 vs 7.1months) and success rate (85.3% vs. 83.5%).
  
  
  CONCLUSIONS
  Implementing a less intensive bracing protocol for PC is successful, efficient and improves compliance.
  
  
  METHODS
  Clinical Research.
  
  
  METHODS
  Oxford Centre for Evidence-Based Medicine Level-of-Evidence rating: Level IV.
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5.
authors.forename: George
authors.initials: G
authors.lastname: Wahba
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada K1H 8L1.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada K1H 8L1. Electronic address: mbettolli@cheo.on.ca.
authors.forename: Marcos
authors.initials: M
authors.lastname: Bettolli
mesh_terms: D000293:Adolescent; D001915:Braces / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009139:Musculoskeletal Abnormalities / Q000628:therapy; D010349:Patient Compliance; D066166:Pectus Carinatum / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome
keywords: Chest wall deformity; External bracing; Nonoperative treatment; Pectus carinatum; Systematic review