title: Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline.
abstract: The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise.
  
  
  
  The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries.
  
  
  
  The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres.
  
  
  
  An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed.
  
  
  
  7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery.
  
  
  
  The process established a new network of opinion leaders and researchers for further guideline development and multicentre research. A structured referral form is available for primary care, including referral recommendations.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Coroneos
authors.affiliation: Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sophocles H
authors.initials: SH
authors.lastname: Voineskos
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marie K
authors.initials: MK
authors.lastname: Christakis
authors.affiliation: Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Achilleas
authors.initials: A
authors.lastname: Thoma
authors.affiliation: Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: James R
authors.initials: JR
authors.lastname: Bain
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
mesh_terms: D001720:Birth Injuries / Q000175:diagnosis* / Q000628:therapy; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis* / Q000628:therapy; D002170:Canada; D032921:Consensus; D000072700:Conservative Treatment; D003697:Delphi Technique; D019468:Disease Management; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures; D009774:Obstetrics; D010348:Patient Care Team; D011247:Pregnancy; D012017:Referral and Consultation; D012307:Risk Factors; D013997:Time Factors
keywords: OBSTETRICS