Hip surveillance in cerebral palsy: Review of clinical practice in a tertiary children's hospital using electronic health record linkage.

Abstract

Children with cerebral palsy (CP) can develop neuromuscular hip dysplasia (NHD) and radiographic surveillance is recommended, guided by gross motor function classification system (GMFCS) level. This study evaluated the clinical practice of hip surveillance for NHD in a children's hospital and risk factors for abnormal first and subsequent X-rays. Health data were extracted for 159 participants with CP, 98 male, 52 GMFCS level IV or V (birth years 2008-2018) and linked to electronic radiology datasets. The median age at diagnosis of CP was 18 months (1-96 months). Thirty-eight participants had X-rays prior to diagnosis and 10 (6%) had no X-ray. Seventy-nine of 111 children classified as GMFCS levels II to V (71%) met both 2008 and 2020 Australian Hip Surveillance Guidelines (AHSG) having the first hip X-ray by 24 months of age. Sixteen participants (11%) had abnormal first hip X-ray (subluxation or migration percentage >30% in 14; MP 90%-100% or dislocation in 2). Univariate analyses showed NHD (MP > 30%) or dislocation at first X-ray was associated with GMFCS IV or V (OR = 6.98 (2.12-22.94), P = 0.001); >4 months between diagnosis and first hip X-ray (OR = 5.60 (1.52-20.59), P < 0.0009) and more common in NZ Māori children than non-Māori children (OR = 3.71 (1.25-11.01), P = 0.012). Surveillance for NHD did not follow guidelines in almost a third of children, with delays in screening associated with greater risk of NHD at first X-ray. Inequities found for Indigenous NZ Māori children with CP require further investigation and stakeholder consultation.