Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum: The Titanic index | Titanic Index (TI) | Percentage of the sternum that lied behind the anterior costal line observed in the CT | Retrospective Single Center | July 2020 - April 2022 | Results: In 78 patients | Significant mild correlation between TI and Correction index (CI) | Significant but weak correlation between TI and Haller Index (HI) | Conclusion: This is a new index for the categorization of the chest wall deformity in patients with pectus excavatum. | TI may help to plan in advance the number of implants require for a complete remodellation of the thorax. | TI is a better predictor of the need for more than two implants. | A TI larger than 66.5% has Sensitivity= 93% & Specificity=92% | https://doi.org/10.1016/j.jpedsurg.2022.12.010 | @StayCurrentMD | Source: Bellia-Munzón G et al. | Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina | @gigenace | Cincinnati Children's | Journal of Pediatric Surgery
Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum: The Titanic index
Infographic · Jun 2023 · 1 min read
In brief
In brief
The Titanic Index quantifies the craniocaudal extent of pectus excavatum deformity using CT imaging, complementing traditional Haller and Correction indices. Retrospective analysis of 78 MIRPE patients demonstrates TI correlates with surgical complexity, offering potential utility in preoperative planning for implant requirements.
- The Titanic index measures cephalocaudal extent of pectus excavatum, complementing traditional severity metrics like Haller index.
- TI >66.5% predicts need for >2 bars during MIRPE with 93% sensitivity and 92% specificity, superior to HI and CI.
- Mean TI of 37% in 78-patient cohort; patients requiring multiple bars were older with worse thoracic indices.
- TI aids surgical planning by quantifying longitudinal deformity extent, not just maximum depth at single point.
- Novel preoperative tool improves bar number estimation for complete thoracic remodeling in minimally invasive repair.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with icons including a calendar, CT scan illustration, and chest/ribcage diagram. The layout is divided into sections showing study design at top, results in the middle with visual elements, and conclusions in a yellow box on the right. Icons illustrate the retrospective study design and anatomical concepts.
New infographic by Cecilia Gigena
"Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum: The Titanic index"
Authors: Gastón Bellía-Munzón, Daniela Sanjurjo, Luzía Toselli, Maxroxia Vallee, Gastón Elmo, Marcelo Martínez-Ferro
DOI: https://doi.org/10.1016/j.jpedsurg.2022.12.010
Abstract
Background/Purpose
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).
Results
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%.
Conclusion
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.