Caving In: Predictive Model for Symptom Progression in Pectus Excavatum.

INTRODUCTION: Pectus excavatum (PE) is the most common chest wall deformity in children, marked by a sunken sternum and costal cartilages. Surgical decisions are often based on clinical judgment, patient and family preferences, and the presence of symptoms. This study aims to develop an evidence-based model that predicts symptom progression based on clinical examination, radiographic results, and physiologic tests. METHODS: A retrospective cohort study was conducted among pediatric patients diagnosed with PE confirmed by physical examination and imaging. Inclusion criteria included age <18 y and at least one year of follow up after completing pulmonary, cardiac, and imaging studies. Data collected included demographics, comorbidities, Haller Index at diagnosis, degree of sternal rotation, clinical symptoms, pulmonary function test, and echocardiogram results. Multivariate and univariate logistic regression analyses were performed to identify factors associated with symptom progression. RESULTS: Among 81 patients, the median time to follow up was 2 [interquartile range 1-3] years. Cardiac malposition emerged as the strongest predictor of symptom progression, with an odds ratio of 3.75 (P = 0.0465, confidence interval = [1.157, 12.07]), indicating a higher likelihood of symptom progression. Notably, traditional clinical markers such as Haller Index and pulmonary function test were not found to be significant predictors of symptom progression. CONCLUSIONS: Cardiac malposition appears to be a strong predictor of symptom progression in PE and may serve as a useful screening tool to determine the need for surgical intervention. These findings can help guide discussions with patients and families when considering an operation for PE.