Shoulder Dystocia and Brachial Plexus Injury: A Population-Based Study

2002 ◽  
Vol 53 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Magnus Christoffersson ◽  
Hakan Rydhstroem
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Population Based ◽  
Shoulder Dystocia ◽  
Population Based Study

scholarly journals Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

2016 ◽  
Vol 17 (2) ◽  
pp. 222-229 ◽  
Author(s):  
Christopher J. Coroneos ◽  
Sophocles H. Voineskos ◽  
Marie K. Coroneos ◽  
Noor Alolabi ◽  
Serge R. Goekjian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Brachial Plexus ◽  
Healthcare System ◽  
Quality Indicators ◽  
Brachial Plexus Injury ◽  
Shoulder Dystocia ◽  
Publicly Funded ◽  
Universal Healthcare ◽  
Universal Healthcare System

OBJECT The aim of this study was to determine the volume and timing of referrals for obstetrical brachial plexus injury (OBPI) to multidisciplinary centers in a national demographic sample. Secondarily, we aimed to measure the incidence and risk factors for OBPI in the sample. The burden of OBPI has not been investigated in a publicly funded system, and the timing and volume of referrals to multidisciplinary centers are unknown. The incidence and risk factors for OBPI have not been established in Canada. METHODS This is a retrospective cohort study. The authors used a demographic sample of all infants born in Canada, capturing all children born in a publicly funded, universal healthcare system. OBPI diagnoses and corresponding risk factors from 2004 to 2012 were identified and correlated with referrals to Canada’s 10 multidisciplinary OBPI centers. Quality indicators were approved by the Canadian OBPI Working Group’s guideline consensus group. The primary outcome was the timing of initial assessment at a multidisciplinary center, “good” if assessed by the time the patient was 1 month of age, “satisfactory” if by 3 months of age, and “poor” if thereafter. Joinpoint regression analysis was used to determine the OBPI incidence over the study period. Odds ratios were calculated to determine the strength of association for risk factors. RESULTS OBPI incidence was 1.24 per 1000 live births, and was consistent from 2004 to 2012. Potential biases underestimate the level of injury identification. The factors associated with a very strong risk for OBPI were humerus fracture, shoulder dystocia, and clavicle fracture. The majority (55%–60%) of OBPI patients identified at birth were not referred. Among those who were referred, the timing of assessment was “good” in 28%, “satisfactory” in 66%, and “poor” in 34%. CONCLUSIONS Shoulder dystocia was the strongest modifiable risk factor for OBPI. Most children with OBPI were not referred to multidisciplinary care. Of those who were referred, 72% were assessed later than the target quality indicator of 1 month that was established by the national guideline consensus group. A referral gap has been identified using quality indicators at clinically relevant time points; this gap should be addressed with the use of knowledge tools (e.g., a clinical practice guideline) to target variations in referral rates and clinical practice. Interventions should guide the referral process.

IS SHOULDER DYSTOCIA WITH BRACHIAL PLEXUS INJURY PREVENTABLE?

2008 ◽  
Vol 19 (4) ◽  
pp. 293-310 ◽  
Author(s):  
EMILY F HAMILTON ◽  
ANTONIO CIAMPI ◽  
ALINA DYACHENKO ◽  
HENRY M LERNER ◽  
LOUISE MINER ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Medical Profession ◽  
Shoulder Dystocia ◽  
Social Consequences ◽  
Obstetrical Complications ◽  
The Family ◽  
Poor Care

The sequelae of shoulder dystocia with persistent brachial plexus injury (BPI) are among the most serious of obstetrical complications. Shoulder dystocia with BPI generally places second or third in the list of the top causes of permanent birth-related neonatal injuries. Apart from the devastating medical and social consequences of lifelong impairment for the family, ensuing litigation with its allegations regarding poor care exacts a heavy toll on the medical profession.

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