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Brachial plexus birth injuries and the association between pre-procedure and post-procedure pediatric outcomes data
Kendra L Eckstein1, Allison Allgier2, Nathan K Evanson3,4
1Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Procedures improve quality of life for children with brachial plexus birth injuries (BPBI). This study found that interventions positively impacted upper extremity and global functioning scores, enhancing overall well-being.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Brachial plexus birth injuries (BPBI) affect 1.5 per 1,000 live births, impacting arm function and sensation.
- The brachial plexus network originates from cervical nerves C5-C8 and T1, controlling arm movement and sensation.
- Assessing the impact of interventions on quality of life is crucial for managing BPBI.
Purpose of the Study:
- To evaluate the change in musculoskeletal health-related quality of life in pediatric patients with BPBI.
- To utilize the Pediatric Outcomes Data Collection Instrument (PODCI) to measure quality of life changes.
- To correlate PODCI scores with procedure history, injury extent, and demographics.
Main Methods:
- Retrospective analysis of 81 pediatric patients (2-18 years) with BPBI from 2002-2017.
- Utilized pre- and post-procedure PODCI scores (Upper Extremity and Global Functioning) stratified by Narakas Classification.
- Paired t-test and ANOVA were used to analyze data from an interdisciplinary Brachial Plexus Center.
Main Results:
- Patients with BPBI exhibited lower PODCI scores compared to healthy peers.
- Post-procedure scores for Upper Extremity (UE) and Global Functioning (GFx) improved in Narakas I and IV classifications.
- A significant correlation was found between initial PODCI scores and age at intervention.
Conclusions:
- Interventions, including surgical and Botulinum Toxin procedures, enhance perceived quality of life in children with BPBI.
- Procedures led to increased PODCI scores in both UE and GFx domains.
- Optimizing treatment timing and type can improve functional outcomes and quality of life for BPBI patients.
Background:
The brachial plexus is a network of nerves exiting the spinal cord through the fifth, sixth, seventh, and eighth cervical nerves (C5-C8) as well as the first thoracic nerve (T1) to conduct signals for motion and sensation throughout the arm. Brachial plexus birth injuries (BPBI) occur in 1.5 per 1,000 live births. The purpose of this study was to determine the perceived change in musculoskeletal health-related quality of life of brachial plexus patients utilizing the Pediatric Outcomes Data Collection Instrument (PODCI). PODCI scores were examined along with the patient's procedure history (surgical or Botulinum Toxin), extent of involvement and demographics.
Patients:
A total of 81 patients from two to eighteen years of age from nine different states met the inclusion criteria of having a pre-procedure and post-procedure PODCI score along with a Narakas score from 2002-2017. These patients were seen at the Brachial Plexus Center, which is an interdisciplinary clinic at a large academic medical centerMETHODS: This retrospective study utilized PODCI data collected annually during their regular brachial plexus clinic visits. Upper extremity (UE) and global functioning (GFx) scores pre- and post-procedure were stratified by Narakas Classification. Data were analyzed using paired t-test and ANOVA testing.
Results:
Patients with a Brachial Plexus Birth Injury (BPBI) had lower PODCI scores for UE and GFx when compared with the pediatric normative scores for age-matched healthy children. Scores in both UE and GFx domains were higher after procedure in the groups of Narakas I and IV. There was significant correlation between UE and GFx scores and documented first PODCI score (2 years of age) and age at intervention (5 years of age).
Conclusion:
Procedures increased the perceived quality of life for children with a BPBI and increased their overall PODCI scores for both UE and GFx.
