Status in Scotland
The evidence base for chest wall bracing in people with pectus carinatum consists largely of lower-level observational studies (case series). These studies consistently report that chest wall bracing in people with pectus carinatum is a safe, and clinically effective alternative to surgery, which is acceptable to most patients. Some people may still require surgery if, for example, chest wall bracing fails or is not appropriate in practice.
The evidence base is heterogeneous, particularly with regard to the bracing protocol used (including wear time and duration of treatment), the selection of patients and how clinical outcomes are measured.
People with pectus carinatum may have reduced self-esteem and body image. Successful treatment is associated with improved patient outcomes such as body image and quality of life
Accurate selection of patients based on age, pressure of initial correction and motivation appears to be important. High attrition rates were reported in several studies, where the treatment was abandoned for reasons including skin issues, discomfort, lack of motivation, slow/no improvement in the pectus carinatum and lengthy treatment durations. Protocols may be improved by addressing pain reduction, skin problems and discomfort. Family support was also associated with improved adherence. Rapid or immediate improvements in the pectus carinatum may increase patient motivation to continue with treatment.
The existing literature suggests that patients are suitable for dynamic chest wall bracing if the pressure of initial correction does not exceed 7.5 to 10 pounds per square inch (PSI). The literature also suggests that, to avoid skin ulcerations, the pressure of treatment should not exceed 2.5 to 3 PSI.
What were we asked to look at?
The Scottish Health Technologies Group (SHTG) was asked to evaluate the clinical effectiveness, cost effectiveness, safety and patient experience of orthotic bracing in people who have pectus carinatum (sometimes known as pigeon chest).
Why is this important
The primary concern associated with pectus carinatum often relates to its physical appearance, and the potential impact of this on a child or young person’s quality of life and mental wellbeing. Less commonly, physical health issues have been reported in the literature.
The Scottish National Chest Wall Service, based in the Royal Hospital for Children Glasgow, offers conservative treatment for children and adolescents (up to 16 years old) in Scotland with pectus carinatum. They requested this work to inform treatment plans and enhance patient care, and to inform National Services Division (NSD) who fund the service.
The Scottish National Chest Wall Service based in the Royal Hospital for Children Glasgow