Five-year outcome of state-wide hip surveillance of children and adolescents with cerebral palsy.
This study reports the five-year outcomes of a prospective population-based study of clinical hip surveillance for children with cerebral palsy (CP) according to evidence-based standards of care. Systematic hip surveillance commenced in Queensland, Australia as a state-wide program in 2005. Queensland represents a dispersed population across a large geographical area, creating unique challenges in terms of service delivery. Over five years, 1,115 children with CP were recruited, representing 73% of the expected population based on 1.9 to 2.1 per 1,000 live births. Standardized clinical and radiological assessments have been provided, with a median follow-up of 1.2 years (range 1 month -5(+8) yrs). Of the 1,115 children, 423 (38%) have been discharged and 692 (62%) remain on surveillance with 314 (28%) identified as having hip displacement with Migration Percentage (MP) equal to or greater than 30% (≥ 30). The incidence of marked hip displacement (MP ≥ 30) was directly related to gross motor function, classified according to the gross motor function classification system (GMFCS), with distribution of GMFCS I=10, (3%), II=40 (13%), III=53 (43%), IV=96 (59%), and V=115 (64%). This state-wide surveillance program has been successful in correctly identifying children with hip displacement (MP ≥ 30), fast tracking children for orthopedic review and discharging those at minimal risk. No child has progressed to dislocation while on surveillance without orthopedic review.
Queensland Cerebral Palsy Health Service, Royal Childrens Hospital, Brisbane, QLD, Australia. megan_kentish@health.qld.gov.au
M
M
Kentish
M
M
Wynter
N
N
Snape
R
R
Boyd
D002547:Cerebral Palsy / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011793:Queensland / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D059039:Standard of Care