Long-term results are still lacking.A single-center study reported in the Journal of Pediatric Surgery found that use of vacuum bell therapy resulted in an excellent correction in twenty percent of patients, but "is not a substitute for the Nuss procedure which can achieve an excellent result in 90% of patients". Variables predictive of an excellent outcome include age ≤ 11 years, chest wall depth ≤ 1.5 cm, chest wall flexibility, and vacuum bell use over 12 consecutive months.In an article by Interactive Cardiovascular and Thoracic Surgery, the results found that vacuum bell treatment is safe for correcting the deformity non-surgically. The treatment has been shown to have higher success rates in patients who present earlier, have a mild and/or symmetrical deformity, a flexible chest wall and lack of costal flaring.The vacuum bell can also be used in preparation to surgery. Orthoses
Brazilian orthopedist Sydney Haje developed a non-surgical protocol for treating pectus carinatum as well as pectus excavatum. The method involves wearing a compressive orthosis and adhering to an exercise protocol.Mild cases have also reportedly been treated with corset-like orthopedic support vests and exercise. Thoracic surgery
There has been controversy as to the best surgical approach for correction of pectus excavatum. It is important for the surgeon to select the appropriate operative approach based on each individuals characteristics. Surgical correction has been shown to repair any functional symptoms that may occur in the condition, such as respiratory problems or heart murmurs, provided that permanent damage has not already arisen from an extremely severe case.
With the release of the Diagnostic and Statistical Manual of Mental Disorders–5th Edition (DSM-V) in May 2013, the diagnosis for PDD was removed and replaced with autism spectrum disorders. Distinction between the past disorders is implicated by a series of severity levels. Individuals who received diagnoses based on the DSM-IV maintain their diagnosis under the autism spectrum disorders. However, an editorial published in the October 2012 issue of American Journal of Psychiatry notes that, while some doctors argue that there is insufficient evidence to support the diagnostic distinction between ASD and PDD, multiple literature reviews found that studies showing significant differences between the two disorders significantly outnumbered those that found no difference.Unlike the DSM-V, the World Health Organization’s International Classification of Diseases, 10th edition (ICD-10) categorizes PDD into four distinct subtypes, each with their own diagnostic criteria. The four disorders (childhood autism, atypical autism, Rett syndrome, and other childhood disintegrative disorder) are characterized by abnormalities in social interactions and communication.The disorders are primarily diagnosed based on behavioral features, although the presence of any medical conditions are important, they are not taken into account when making a diagnosis.Before the release of the DSM-V, some clinicians used PDD-NOS as a "temporary" diagnosis for children under the age of five when, for whatever reason, they are reluctant to diagnose autism. There are several justifications for this. Very young children have limited social interaction and communication skills to begin with, so it can be tricky to diagnose milder cases of autism in toddlers.