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Cerebral palsy and clinical negligence litigation: a cohort study
Catherine Greenwood1, Sally Newman, Lawrence Impey
1National Perinatal Epidemiology Unit, Oxford, UK.
Insights
The presence of three essential criteria for acute intrapartum hypoxia in children with cerebral palsy was more likely in legal claims, but did not influence claim outcomes. These criteria are common in all cerebral palsy cases.
Area of Science:
- Neurology
- Pediatrics
- Medical Law
Background:
- Cerebral palsy (CP) is a complex neurological disorder.
- Identifying the causes of CP, particularly intrapartum events, is crucial for clinical and legal contexts.
- The International Cerebral Palsy Task Force defined essential criteria for acute intrapartum hypoxia.
Purpose of the Study:
- To compare the prevalence of criteria for acute intrapartum hypoxia in children with cerebral palsy (CP).
- To investigate the association between these criteria and clinical negligence legal claims in CP cases.
Main Methods:
- A nested cohort study was conducted using a geographically defined population.
- Singleton children with CP born between 1984 and 1993, excluding postnatal causes, were included.
- Medical records were retrospectively reviewed by a blinded observer.
Main Results:
- One-fifth of CP children were involved in legal claims.
- The presence of all three essential criteria for acute intrapartum hypoxia was more likely in legal claims (P < 0.01).
- However, in most claims (74%), all three criteria were not met, and a significant proportion (36%) of those meeting all criteria did not file a claim. The criteria did not influence claim settlement.
Conclusions:
- The defined essential criteria for acute intrapartum hypoxia are highly prevalent in children with cerebral palsy.
- While more common in legal claims, the presence of these criteria did not significantly impact claim outcomes.
- Further observation is needed to determine if these criteria influence judicial decisions in CP cases.
Objective:
To compare the prevalence of criteria suggesting acute intrapartum hypoxia in children with cerebral palsy who have and have not been the subjects of clinical negligence legal claims.
Design:
Nested cohort study within a geographically defined cohort.
Setting:
The former Oxfordshire Health Authority.
Population:
Singleton children with cerebral palsy born between 1984 and 1993, excluding cases with a recognised postnatal cause for cerebral palsy.
Methods:
Retrospective review of medical records by blinded observer.
Main Outcome Measures:
Three 'essential' criteria defined by the International Cerebral Palsy Task Force which identify acute intrapartum hypoxia.
Results:
One-fifth (27/138) of all singleton cerebral palsy children were the subject of a legal claim. The presence of all three criteria was significantly more likely to lead to a legal claim (P < 0.01), but in 74% (20/27) of claims, all three were not fulfilled and 36% (4/11) of those satisfying all three criteria did not claim. At least one of the three criteria was met in 82% (91/111) of the cases where there was no claim. Data on fetal or neonatal arterial blood gases were available in only 57% (78/138). Of the 27 claims, 12 were discontinued, 8 were settled and in 7 the legal process is still pending. The presence of the three essential criteria for acute intrapartum hypoxia did not increase the likelihood of a legal claim being settled.
Conclusion:
The prevalence of the 'template essential' criteria is high in all cases of cerebral palsy. Although the presence of all three essential criteria was more likely in the claims group, this did not appear to influence the outcome of a claim. It remains to be seen whether the existence of the template leads to change in the pattern of decisions made by the courts.