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Cerebral palsy diagnosis and the impact on hip surveillance enrollment
Jaimy Coates1, Kishore Mulpuri1,2, Jennifer Farr1
1Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
Insights
Hip surveillance in children is crucial. Many children without a confirmed cerebral palsy (CP) diagnosis are enrolled, highlighting the need for broader inclusion criteria to ensure timely care.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Hip surveillance is vital for children with cerebral palsy (CP) to prevent hip dislocation.
- Accurate diagnosis at enrollment is essential for appropriate management within surveillance programs.
Purpose of the Study:
- To examine the diagnostic accuracy at enrollment in a hip surveillance program for children with cerebral palsy (CP).
- To review the etiologies of children enrolled without a confirmed CP diagnosis.
Main Methods:
- Retrospective review of data from 959 children enrolled in the Child Health British Columbia Hip Surveillance Program (September 2015 - December 2019).
- Analysis included enrollment diagnosis, Gross Motor Function Classification System level, migration percentage, and age at enrollment.
- Chart reviews confirmed diagnoses, and etiologies were compared against CP registry criteria.
Main Results:
- Cerebral palsy (CP) was the confirmed diagnosis for 73% of enrolled children.
- A significant proportion (23%) were enrolled with an 'other' diagnosis, and 13% with 'possible CP'.
- 11.1% enrolled as 'possible CP' or 'other' were confirmed to have CP; 5.8% did not have CP due to progressive conditions.
Conclusions:
- Approximately one in four children entered hip surveillance without a confirmed CP or possible CP diagnosis.
- Expanding hip surveillance participation to children meeting clinical CP criteria, even without a formal diagnosis, can enhance access to care and improve outcomes.
Aim:
To investigate the diagnosis at enrollment in the Child Health British Columbia Hip Surveillance Program for Children with Cerebral Palsy (CP) and review the etiologies of children enrolled without a CP diagnosis.
Method:
Data from 959 children (543 males, 416 females; mean [SD] age at enrollment 6 years 8 months [4 years 2 months]) enrolled in the program between September 2015 and December 2019 were retrospectively reviewed. Enrollment diagnosis, Gross Motor Function Classification System level, migration percentage, and age at enrollment were included. Chart reviews were completed to confirm diagnoses for all children. Etiologies were compared to a list of conditions that are included and excluded from CP registries.
Results:
Diagnosis at enrollment was CP for 612 (64%), possible CP for 120 (13%), and 'other' for 220 (23%). No diagnosis was provided for seven (<1%). CP was confirmed for 700 (73%), including 106 (11.1%) enrolled as 'possible CP' or 'other'; 56 (5.8%) did not have CP due to progressive conditions. Migration percentage was similar across all groups at enrollment.
Interpretation:
One in four children were enrolled in hip surveillance without a diagnosis of CP or possible CP. Encouraging participation in hip surveillance when children meet the clinical criteria for CP but do not have a confirmed CP diagnosis can improve access to care.
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