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Obstetrical Brachial Plexus Palsy: Geographic Information Systems Data on a Single Cohort at a Major Children's Hospital
Christopher Lunsford, MD1; Jack E. Brooker2; Kristen Kurland, BA3; Lorelei Grunwaldt, MD4
1UPMC Children's, Pittsburgh, PA; 2School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; 3H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA; 4University of Pittsburgh, Pittsburgh, PA
Introduction: Obstetrical brachial plexus palsy (OBPP) is very uncommon, occurring in approximately 1.5 of 1,000 total births. Factors related to OBPP previously studied include gestational age, birth weight, maternal parity, and duration of labor. It was noted that presenting cases were disproportionally from underprivileged backgrounds in this major treatment center, however, there are no socio-economic geographic studies.
Methods: An IRB approved retrospective review of all patients presenting to a major children's hospital multidisciplinary brachial plexus clinic was performed from 1992 to 2014. A total of188 patients were initially reviewed. Data was geocoded by patient street address (n=177) and ZIP Code (n=180). Exclusion criteria included lack of address information. Data were analyzed for age, sex, race, location of birth hospital, address of residence, and proximity to birth centers.
Results: Overall, none of the referral hospitals had a higher than normal incidence of OBPP. 57 out of 177 (88.7%) of patients were from the same state and 52/177 (29%) were from the same county as the treating center. When geocoding OBPP patients within the city of the treating center at the neighborhood level (n=24), demographics show a lower than average socio-economic status of these neighborhoods (n=18) compared to the general population of the city. There was a higher undereducated population (16.09% vs 11.40%), lower percentage of residents with bachelor's degrees (21.21% vs 33.80%), and higher percentage of single mothers (22.32% vs 14.30%) in the OBPP cases versus city averages respectively (p=0.0039). When geocoding patients in the state, household income was lower (,650 vs ,267), college degree attainment was lower (23.35% vs 27%) and the number of female households higher (26.47% vs 11.9%) than state averages respectively (p=6.97x10-5). It was noted that more of the presenting cases were African American (13.7% vs 10.9%). Geocoded figures for African American patients showed considerably lower socio economic averages particularly female headed households (42.26% vs 26.08%) compared to the overall patient sample which may explain this racial preponderance.
Conclusion: Our findings suggest a higher incidence in low socio-economic neighborhoods in our cohort compared to regional references. This suggests that accessibility to healthcare, parental education, and marital status may be modifiable factors contributing to OBPP. The use of geospatial analysis for specific diagnoses may provide clues to etiology and suggest public policy responses to improve health care delivery.
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