Abstract
Cerebral palsy (CP) diagnosis is historically late, at between 12 and 24 months. We aimed to determine diagnosis age, fidelity to recommended tests and acceptability to parents and referrers of an early diagnosis clinic to implement a recent evidence-based clinical guideline for the early diagnosis of CP. A prospective observational case series of infants <12 months with detectable risks for CP attending our clinic was completed with data analysed cross-sectionally. Infants had a high risk of CP diagnosis at a mean age of 4.4 (standard deviation [SD] 2.3) months and CP diagnosis at 8.5 [4.1] months. Of the 109 infants seen, 57% had a diagnosis of CP or high risk of CP, showing high specificity to our inclusion criteria. Parent and referrer acceptability of the clinic was high. Paediatricians had the highest rate of referral (39%) followed by allied health (31%), primary carer (14%) and other health workers (16%). Fidelity to the guideline was also high. All infants referred <5 mths had the General Movements Assessment (GMA) and all except one had the Hammersmith Infant Neurological Examination (HINE) administered. N = 92 (84%) of infants seen had neuroimaging, including n = 53 (49%) who had magnetic resonance imaging (MRI), showing recommended tests are feasible. Referral to CP-specific interventions was at 4.7 [3.0] months, sometimes before referral to clinic. Clinicians can be confident CP can be diagnosed well under 12 months using recommended tools. This clinic model is acceptable to parents and referrers and supports access to CP-specific early interventions when they are likely to be most effective.
Highlights
Cerebral palsy (CP) is diagnosed between 12 and 24 months in high-income countries [1,2] and later in low- and middle-income countries, for example, 5 years in Bangladesh [3]
Eight evidence-based knowledge translation (KT) strategies were selected as solutions to overcome barriers to guideline implementation [15,16], including: (1) targeting practitioner attitudes regarding early diagnosis [17]; (2) guideline awareness [18]; (3) knowledge brokers’ use of early diagnosis evidence to inform policymakers within both collaborating institutions; (4) use of opinion leaders [19]; (5) industry experts mentoring clinic staff [20]; (6) medical and parent self-referral to clinic [21]; (7) leveraging on a research active culture, including employing research clinicians [22]; and (8) Neurologist employed as medical lead [23]
Risk of seizures discussion was documented in 79% of infants with CP; 23% of infants had seizure management in place; 13% had seizures identified through clinic; 52% required no seizure management and 13% did not have seizure status documented
Summary
Cerebral palsy (CP) is diagnosed between 12 and 24 months in high-income countries [1,2] and later in low- and middle-income countries, for example, 5 years in Bangladesh [3]. A recent international clinical practice guideline (hereafter termed “guideline”) outlines 12 recommendations, including the best evidence-based assessments, to make an accurate and early diagnosis of CP at 3–12 months of age [1]. NICU follow-up criteria vary, meaning cases are missed Infants not meeting these criteria or those with an uncomplicated birth are typically referred later to a neurologist or paediatrician after parents or a professional identify concerns, e.g., milestone delays or asymmetries, and are usually assessed on the infant risks pathway, meaning diagnosis is made later. (3) seeking two Australian GMA trainers to enable local training; (4) providing financial scholarships to key opinion leaders/brokers These stage one KT strategies improved use of the GMA (and HINE) in NICUs, as evidenced by published data on the GMA’s predictive accuracy [13]. (4) fidelity to evidence pathways in the guideline [1] could be maintained; and (5) parents and referrers would find the clinic acceptable
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