NHS Grampian cerebral palsy hips monitoring protocol - our early experience

Abstract

Introduction Hip displacement is common in children with cerebral palsy (CP). There is a broadly linear relationship between severity of spastic CP and the likelihood of hips problem. Based on this, NHS Grampian introduced a local protocol in March 2008 to guide clinical and radiological monitoring of hips at risk in children with CP. Children are monitored by community paediatricians and referred at intervals for radiographs depending on their age and level of disability (GMFCS scoring). The audit aims to determine if: 1. Current clinical practice followed the recommended protocol 2. Outcome for children following hips X-ray Methods A retrospective case study of patients (0-19.0 years old) currently living in the Grampian with the diagnosis of spastic hemiplegia, spastic diplegia/quadriplegia identified from Support Needs System (SNS) data set. Data is collated from patients CCH notes using a proforma. STANDARDS - All children who fulfil the above criteria should follow the pathway for NHS Grampian CP hips monitoring protocol. POPULATION - 153 children (0-19.0 years old) identified from the SNS meet the criteria for the audit. The incidence of CP in this caseload was 1.6/1000 live births. Results 41 (26.8%) children had hips surveillance X-ray done from March 2008 to 1st August 2010. Total number of children assessing the surveillance hip X-ray is low in the spastic hemiplegia (n=3) and spastic diplegia/quadriplegia (GMFCS I-III, n=17) group. Annual examination was done in 86.3% and 94.3% of these two groups respectively. All children with GMFCS IV-V have annual examination and 21 (65.6%) children have surveillance hips X-ray. From the 41 surveillance hips X-rays, fourteen (34.1%) were abnormal; 10 (71.4%) children are from the GMFCS IV-V group. Five (35.7%) children went on to have surgery and the rest being actively monitored in Orthopaedic clinics. Conclusion Our early experience with this surveillance programme shows that hips problem was detected in one third of the children screened and one third of them went on to have surgery. Local hips monitoring protocol introduces a standardised approach to assess children with CP, resulting in timely referral to Orthopaedics service for further management.