Mortality from 1 to 16-18 years in bilateral cerebral palsy

Abstract

Although there were deaths throughout the childhood and teenage years, the majority of children with bilateral CP are likely to survive to adulthood, especially if they do not have major functional impairment at 2 years. This confirms findings of other studies of children with CP.

Impaired mobility associated with an increased likelihood of death in children: A systematic review

“…This shows an indication of the magnitude of risk associated with each impairment but they are not necessarily directly comparable. The majority of studies reported functioning assessed using nonstandardised measures; two studies reported the Gross Motor Function Classification Scale (GMFCS) (Palisano et al, 2008) level V, (Westbom et al, 2011;Touyama et al, 2013); one study reported GMFCS combining level IV and V. (Baird et al, 2011) The characteristics of included studies are displayed in Table 1. The risk of bias of included studies was judged using the QUIPS checklist.…”

“…Seven papers were reported as retrospective cohort studies (Baird et al, 2011;Touyama et al, 2013;Hemming et al, 2005;Strauss et al, 1998a;Evans et al, 1990;Nielsen et al, 2002;Strauss et al, 1998b), one as case control (Cohen et al, 2008) (with two comparison groups) and one retrospective study of prospectively collected data (initial recruitment for another study, reporting vital status at a later point) (Westbom et al, 2011). This study suggested the data were collected as part of a research project, the remaining studies used routinely collected clinical data.…”

“…Studies used existing datasets, with two using the Client Development Evaluation Report (CDER) (Strauss et al, 1998a;Strauss et al, 1998b), two using registers of cerebral palsy (Westbom et al, 2011;Nielsen et al, 2002) and the remaining five, using clinical records, were reported as retrospective cohort studies (Baird et al, 2011;Touyama et al, 2013;Hemming et al, 2005;Evans et al, 1990;Cohen et al, 2008). Sample sizes ranged from 277 to 12,719 but were not consistently reported.…”

“…Figure 2 shows that the singular factor associated with the highest ratio was 'lack of sitting ability at 24 months' with HR 44.4 (CI. 6.1 to 320.8) (Baird et al, 2011), however, sitting ability is defined as 'getting to any sitting position from any lying position on the floor and then sitting without propping with either arm for 15 seconds'. This equated to 56 out of 200 in the exposed group compared to 1 out of 132 children in the referent group.…”

“…Two studies reported HR for GMFCS level V, with comparable results: 16.3 (CI 5.6 to 47.2), constituting 29 out of 166 children in the exposed group compared to 4 out of 413 in the referent group and 11.4 (CI 3.76 to 35.57) which equated to 25 out of 102 children in the exposed group compared to 5 out of 605 in the referent group (Touyama et al, 2013;Westbom et al, 2011). One study combined GMFCS level IV and V with a reduced HR of 6.2 (CI 2.8 to 14) equating to 55 out of 176 children in the exposed group compared to 2 out of 160 (Baird et al, 2011). In contrast, seemingly less severe impairments such as 'no functional hand use' and 'rolls/sits but cannot walk unaided' (Strauss et al, 1998a) were associated with lower hazard ratios of less than 3.…”