title: Variation in health care for children and young people with cerebral palsies: a retrospective multicentre audit study.
abstract: OBJECTIVE
  To explore the provision and variations in care for children and young people with cerebral palsies (CP) registered with the population-based North of England Collaborative Cerebral Palsy Survey (NECCPS).
  
  
  METHODS
  This is a retrospective multicentre record audit of 389 children with CP (220 males, 148 females, 21 no data; median age at time of audit 12y 3mo), born between 1995 and 2002. Data were collected on cranial magnetic resonance imaging (MRI), hip and spine surveillance and management, and pain presence and management. Variations over time and between the districts in the north of England (Northumberland, North and West Cumbria, North and South Tyneside, Newcastle-upon-Tyne, Gateshead, Sunderland, Durham, Darlington, Bishop Auckland, Hartlepool, Stockton-on-Tees, Middlesbrough, Redcar, and Cleveland), and by socio-economic status (SES) (estimated from the Index of Multiple Deprivation [IMD] 2004) were estimated by generalized estimating equations.
  
  
  RESULTS
  There was significant variation between districts in access to MRI (p<0.001), orthopaedic surgeons (p=0.005), recording state of spine (p<0.001), and discussions about pain (p<0.001). Fifty-seven per cent (95% CI 52-62) had evidence of a reported MRI brain scan, the proportion of which increased over time (p<0.001). Sixty-seven per cent (95% CI 62-71) had a discussion about pain recorded. Of those in pain, 87% (95% CI 80-93) had a pain management plan. The proportion with documented discussion about pain increased with increasing SES (p=0.04).
  
  
  CONCLUSIONS
  The provision of care for children with CP in the north of England varies between districts. Internationally agreed, evidence-based standards are urgently needed to ensure more equitable health care and improved outcomes for all.
authors: City Hospitals Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK.
authors: Karen
authors: K
authors: Horridge
authors: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors: Peter W G
authors: PW
authors: Tennant
authors: County Durham and Darlington NHS Foundation Trust, Durham, UK.
authors: Rajesh
authors: R
authors: Balu
authors: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.|PHE: Regional Maternity Survey Office, Newcastle upon Tyne, UK.
authors: Judith
authors: J
authors: Rankin
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D054869:Clinical Audit; D018672:Community Health Planning; D003695:Delivery of Health Care; D019468:Disease Management; D004739:England; D005260:Female; D006617:Hip Dislocation / Q000209:etiology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010146:Pain / Q000209:etiology; D012189:Retrospective Studies