Brachial plexus birth injuries and the association between pre-procedure and post-procedure pediatric outcomes data collection instrument scores and narakas classification
Affiliations: [a] Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [b] Division of Occupational and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [c] Division of Physical Medicine and Rehab, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [d] Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
Correspondence:
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Corresponding author: Allison Allgier, Division of Occupational and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA. Tel.: +1 513 6367539; Fax: +1 513 8030044; E-mail: allison.allgier@cchmc.org.
Abstract: 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 center METHODS: 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.
