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Implementation of guidelines for early detection of cerebral palsy. A single-site study in Spain
Álvaro Hidalgo-Robles1, María Del Mar Batista-Guerra2, Mónica Gutiérrez-Ortega3
1Universidad Internacional de La Rioja, 26006, Logroño, Spain; INAT (Early Intervention Research Team-Equipo de Investigación en Atención Temprana), Universidad Internacional de La Rioja, 26006, Logroño, Spain.
Insights
Implementing international guidelines for early detection of cerebral palsy (CP) significantly reduced diagnosis and referral times. This study shows earlier identification is feasible, improving outcomes for at-risk infants.
Area of Science:
- Pediatrics
- Neurology
- Public Health
Background:
- International guidelines for early detection of cerebral palsy (CP) exist but face implementation challenges.
- Limited adoption in clinical practice hinders timely diagnosis and intervention for at-risk infants.
Purpose of the Study:
- To implement 2017 international CP detection guidelines in a Spanish hospital.
- To evaluate the impact on the timing of CP diagnosis and early intervention referral.
Main Methods:
- A pre/post observational study with a three-phase implementation strategy.
- Comparison of a historical cohort (2017-2021) with an implementation cohort (2022-2023).
- Systematic screening of infants with high-risk markers for CP.
Main Results:
- Mean age at CP diagnosis reduced by 8.2 months (17.4 to 9.2 months).
- Referral to early intervention occurred at a mean corrected age of 1.9 months in the implementation cohort.
- Partial (50%) or consistent (20%) application of 12 key recommendations was observed.
Conclusions:
- Implementation of CP detection guidelines is feasible and improves identification and surveillance.
- Earlier diagnosis and referral to early intervention are achievable outcomes.
- Structured pathways are necessary for routine integration and equitable access to care.
Abstract:
The 2017 international guidelines for early detection of cerebral palsy (CP) provide a framework for identifying and managing infants at risk. Yet their implementation in clinical practice remains limited in some settings and countries. This study aimed to implement these guidelines in a Spanish tertiary hospital and assess their impact on the timing of CP diagnosis and referral to early intervention. A pre/post observational design was used, structured around a three-phase implementation strategy: (1) planning and preparation, (2) installation, and (3) early implementation of systematic screening of infants with "high-risk" markers. We compared a historical baseline cohort (born 2017-2021, n = 18 children diagnosed with CP) and an implementation cohort (born 2022-2023, n = 57 enrolled, n = 4 children diagnosed with CP). Among infants with CP in the implementation cohort, referral to early intervention occurred at a mean corrected age of 1.9 months, "high-risk" of CP designation at 3.7 months, and CP diagnosis at 9.2 months. In the baseline period, mean age at diagnosis was 17.4 months, yielding a mean reduction of 8.2 months during implementation (95 % CI: -13.8 to -2.6, p < 0.05). Twelve key recommendations were partially (50 %) or consistently (20 %) applied. Findings support the feasibility of implementing the guidelines and suggest improved identification and surveillance outcomes, including earlier diagnosis. Structured implementation pathways are needed to integrate these practices into routine care and promote equitable access across health systems.
