Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

BMJ Open. 2017 Jan 27;7(1):e014141. doi: 10.1136/bmjopen-2016-014141.

Abstract

Objective: The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise.

Setting: The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries.

Participants: The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres.

Outcome measures: An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed.

Results: 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery.

Conclusions: The process established a new network of opinion leaders and researchers for further guideline development and multicentre research. A structured referral form is available for primary care, including referral recommendations.

Keywords: OBSTETRICS.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Birth Injuries / diagnosis*
  • Birth Injuries / therapy
  • Brachial Plexus / injuries*
  • Brachial Plexus Neuropathies / diagnosis*
  • Brachial Plexus Neuropathies / therapy
  • Canada
  • Consensus
  • Conservative Treatment
  • Delphi Technique
  • Disease Management
  • Female
  • Humans
  • Infant, Newborn
  • Male
  • Neurosurgical Procedures
  • Obstetrics
  • Patient Care Team
  • Pregnancy
  • Referral and Consultation
  • Risk Factors
  • Time Factors

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