- •We propose a novel index for determining the cephalocaudal extent of sunken sternum in pectus excavatum.
- •This determination allows preoperative planning of the precise number of implants required.
- •A threshold of 66.5% is sensible and sensitive for the need for more than 3 implants for complete thoracic remodeling.
Quantification of the severity of pectus excavatum deformities is currently performed using the Haller index (HI) and the Correction index (CI), amongst others. However, most indexes characterize the severity at the point of maximum excavation. We present a new index, the Titanic index (TI), aimed at the appraisal of the cephalocaudal extent of the excavation and its potential clinical use.
Materials and methods
Retrospective analysis of a cohort of patients who underwent a minimally invasive repair of pectus excavatum (MIRPE) between July 2020 and April 2022 at a single center. We defined TI as the percentage of the sternum that lied behind the anterior costal line observed in the CT. Demographics, HI, CI, and TI calculated based on computed tomography images (CT) were analyzed. Also, we compared the severity indexes of two groups of patients divided by the number of implants introduced per patient (group A: two implants, and group B: more than two).
Seventy-eight patients (92% male) were included, with a mean age of 17.2 ± 4.8 years. The mean TI was 37%. Albeit weak, we identified significant correlations between the TI and the HI and, more closely, to the CI. Two implants were introduced in 37 (47%) patients, and more than two in 41 (53%) patients. Compared to patients with two implants, the group of patients who received more than two implants were older and showed worse thoracic indexes. Using receiver operating characteristic curve analysis, we identified the TI as a better predictor of the need for more than two implants than HI and CI. In this regard, a TI larger than 66.5% had a sensitivity of 93% and a specificity of 92%.
We propose a novel index for the categorization of the severity of pectus excavatum. This index might be useful in planning the number of implants required for complete thoracic remodeling during MIRPE.
Level of evidence
Type of study
Retrospective Comparative Study.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pediatric Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Changes in chest compression indexes with breathing underestimate surgical candidacy in patients with pectus excavatum: a computed tomography pilot study.J Pediatr Surg. 2013; 48: 2011-2016https://doi.org/10.1016/j.jpedsurg.2013.01.044
- Age-related normal ranges for the Haller index in children.Pediatr Radiol. 2004; 34: 326-330https://doi.org/10.1007/s00247-003-1116-1
- Variation of the Anthropometric index for pectus excavatum relative to age, race, and sex.Clinics. 2013; 68: 1215-1279https://doi.org/10.6061/clinics/2013(09)07
- Growth disturbance of the sternum and pectus deformities: imaging studies and clinical correlation.Pediatr Radiol. 1999; 29: 334-341https://doi.org/10.1007/s002470050602
- Reliability of a standardized protocol to calculate cross-sectional chest area and severity indices to evaluate pectus excavatum.J Pediatr Surg. 2006; 41: 1219-1225https://doi.org/10.1016/j.jpedsurg.2006.03.003
- A novel measure for pectus excavatum: the correction index.J Pediatr Surg. 2011; 46: 2270-2273https://doi.org/10.1016/j.jpedsurg.2011.09.009
- Classification of the dysmorphology of pectus excavatum.J Pediatr Surg. 2006; 41: 1573-1581https://doi.org/10.1016/j.jpedsurg.2006.05.055
- New computerized tomogram (CT) indices for pectus excavatum: tools for assessing modified techniques for asymmetry in Nuss repair.Chest. 2004; 126: 777Shttps://doi.org/10.1016/s0012-3692(16)46588-8
- A 10-year review of a minimally invasive technique for the correction of pectus excavatum.J Pediatr Surg. 1998; 33: 545-552https://doi.org/10.1016/S0022-3468(98)90314-1
- From bench to bedside: 3D reconstruction and printing as a valuable tool for the chest wall surgeon.J Pediatr Surg. 2020; 55: 2703-2709https://doi.org/10.1016/j.jpedsurg.2020.07.010
- Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report.J Pediatr Surg. 1987; 10: 904-906
Published online: December 22, 2022
Accepted: December 12, 2022
Received: November 29, 2022
© 2022 Elsevier Inc. All rights reserved.