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Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline
  1. Christopher J Coroneos1,2,
  2. Sophocles H Voineskos1,2,
  3. Marie K Christakis3,
  4. Achilleas Thoma1,2,
  5. James R Bain1,
  6. Melissa C Brouwers2,4
  7. on behalf of The Canadian OBPI Working Group
    1. 1Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
    2. 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
    3. 3Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
    4. 4Department of Oncology, McMaster University, Hamilton, Ontario, Canada
    1. Correspondence to Dr James R Bain; bainj{at}hhsc.ca

    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.

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    Footnotes

    • Twitter Follow Christopher Coroneos @cjcoroneos

    • Collaborators The Canadian OBPI Working Group: James Bain (McMaster University), Michael Bezuhly (Dalhousie University), Sean G Bristol (University of British Columbia), Kevin Cheung (University of Ottawa), Howard M Clarke (University of Toronto), Kristen M Davidge (University of Toronto), A Robertson Harrop (University of Calgary), Jennifer C Lin (Université de Montréal), Jaret L Olson (University of Alberta), Douglas C Ross (Western University), Constantin Stanciu (Université de Montréal), David Tang (Dalhousie University), Susan Thompson (University of Winnipeg), Cynthia Verchere (University of British Columbia), and Yvonne Ying (University of Ottawa).

    • Contributors CJC was involved in conception and design; acquisition, analysis and interpretation of data; drafting of the manuscript; statistical analysis; obtaining funding. SHV was involved in conception and design; acquisition and interpretation of data; drafting of the manuscript; obtaining funding. MKC was involved in acquisition of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; obtaining funding. AT was involved in conception and design; critical revision of the manuscript for important intellectual content; supervision; obtaining funding. JRB and MCB were involved in conception and design; critical revision of the manuscript for important intellectual content; supervision; obtaining funding.

    • Funding CJC received unrestricted academic grants to fund research fellowship training: (1) the Canadian Institutes of Health Research (CIHR) Master's Award: Frederick Banting and Charles Best Award. (2) Father Sean O'Sullivan Research Centre Award, St Joseph's Healthcare, Hamilton, Ontario, Canada. (3) Juravinski Surgical Fellowship, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. The Canadian OBPI Working Group received a Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

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