LAUSR

Introduction Cerebral Palsy (CP) is the most prevalent cause of physical disability affecting children in developed countries with an incidence of 2/1000 live births.(1). The risk of hip displacement increases with increasing severity of spasticity with up to 75% of those with spastic quadriplegia having hip displacement. (2,3) The intensity of screening increases with increasing gross motor function classification score (GMFCS). Aims The aim of this re-audit was to improve hip surveillance among children with CP following a previous audit in October. Intervention A multidisciplinary meeting resulted in a single set of nationally and internationally approved guidelines being approved for introduction: Cerebral Palsy Integrated Pathway, Scotland (CPIPS). A pro forma for clinical visits was introduced for patients with CP with a single page pictorial guide to simplify the use of these guidelines were added to this. A standard of 90% was set. Methodology There was a retrospective review of all patients reviewed in clinic in the last 3 months with Cerebral Palsy less than 18 years old. The radiology system ‘NiMIS’ was used to check for evidence of imaging and clinic letter was reviewed for evidence of clinical examination. The patients were classified according to their GMFCS group and results documented as ‘Yes’ ‘No’ if compliant to one or both guidelines and ‘Don’t know’ if the images were not available on NIMIS. Results 12 patients were included in this re-audit with the overall compliance being 90%. GMFCS 1 included 3 patients all meeting the surveillance guidelines. GMFCS 2 included 3 patients with 100% compliance. GMFCS 3 included 2 patients with 50% compliance. GMFCS 4 had no patients. GMFCS 5 included 4 patients with 100% compliance and Hemiplegic Gait Group included 1 patient with 100% compliance. Conclusion We are now above the standard set for compliance to these guidelines. The re-audit was over a shorter time with fewer patients, however it does suggest an initial positive change. The plan will be to re-audit again in six months and a years’ time to ensure that this level of compliance is maintained. References Soo B, Howard JJ, Boyd RN, et al. Hip displacement in cerebral palsy.J Bone Joint Surg Am.2006;88:121–129. doi: 10.2106/JBJS.E.0007 Lonstein JE, Beck K. Hip dislocation and subluxation in cerebral palsy. J Pediatr Orthop. 1986;6:521–526. doi: 10.1097/01241398-198609000-00001. Bagg MR, Farber J, Miller F. Long-term follow-up of hip subluxation in cerebral palsy patients. J Pediatr Orthop.