A population of children with cerebral palsy in Queensland; Ten years of hip surveillance

Abstract

Objective: Systematic state-wide hip surveillance (HS) for children with cerebral palsy (CP) commenced in Queensland (Qld) in 2005. This paper reports outcomes of Reimer's migration percentage (MP) ≥ 30% and hip dislocation according to classification of motor function using the Gross Motor Function Classification System (GMFCS) from ten years of systematic HS based on published protocols. Study Design: Prospective population based study. Methods: Qld HS has been implemented according to 2008 Consensus Statement and more recently the 2014 Australian HS Guidelines. HS is coordinated centrally by tertiary health services. Children with MP≥ 30% are referred to orthopaedics for individual management in line with published guidelines. HS data is stored on a secure web-based information system which supports detailed analysis of patient outcomes and factors that influence risk of hip displacement in this population. Results: For children with cerebral palsy, birth years 1995-2016, the total cohort n=2278 represents: 1 GMFCS I, n=837 (37%) with 31 (3.7%) of these children having MP≥30% at any time; 2 GMFCS II, n=563 (25%) with 80 (14%) of children having MP≥30% at any time, 38 remain on active surveillance, 3 lost to follow up, 29 resolved by discharge and the remaining 10 were referred to orthopaedics; 3 GMFCS III, n=204 (9%) with 102 (50%) of this group having MP≥30% at any time; 4 GMFCS IV, n=326 (14%) with 210 (64 %) of these children having MP≥30% at any time; 5 GMFCS V, n=348 (15 %) with 258 (74 %) having MP≥30% at any time. Hip dislocations, n=43, occurred within the total cohort. 27 children were already dislocated at initial entry to HS. The remaining 16 children were referred to orthopaedics or deemed palliative/unfit for surgery. Reasons for dislocation whilst under orthopaedic care included failed surgery, delay to surgery or parents not consenting to surgery. Conclusions: This cohort is the largest reported to date. The population data and outcomes are similar to other reported CP populations with the incidence of children with MP≥ 30% consistent with earlier studies. The Qld HS Program working in accordance with evidence-based guidelines has been successful in correctly identifying children at risk of hip displacement, fast tracking children at high risk to orthopaedic treatment and discharging those at minimal risk. No child progressed to dislocation without referral to orthopaedics. This paper provides opportunity for further refinement of guidelines to ensure surveillance is relative to risk of hip displacement for children with CP.L6213533312018-03-27 <br />