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Impact of Area of Deprivation Index and Urban-Rural Geography on Outcomes in Obstetric Brachial Plexus Palsy
Casey Zhang, BS; Alexander Comerci BA; Angel Dixon BS; Nerone Douglas, MS; Anne Glenney BS; Alexander Davit, MD
University of Pittsburgh Medical Center
2024-01-13
Presenter: Casey Zhang
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. I certify that this work entirely represents the original work of the resident or medical student.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Background:
Obstetric brachial plexus palsy (OBPP) is a serious complication of birth. When evaluating infants for OBPP, potential barriers to care must be considered to promote successful follow-up. This study aims to assess the role of socioeconomic context on clinical and surgical outcomes for OBPP patients.
Methods:
A retrospective review was performed for OBPP infants who presented to Children's Hospital of Pittsburgh from 2008 to 2020. Area of Deprivation Index (ADI) and urban-rural locale were collected for each patient. Outcomes of interest included complete recovery, surgical intervention, and follow-up duration. Multivariate regression was performed to identify associations with OBPP outcomes.
Results:
Of 195 patients that met inclusion criteria, 73 (37.4%) patients underwent surgery (x = 1.3 ± 2.2 years) with a median ADI of 76. Thirty-two percent (31.8%) of patients were of rural locale and 23.3% of patients were of non-white background. Rural location was significantly associated with decreased surgical intervention (OR 0.5, CI 0.256-0.982, p=.04). Higher ADI significantly correlated with lower AMS scores at 9 months and at most recent follow-up (R2 = -0.31, p=.004; R2=-0.136, p=.04). Non-white background was significantly associated with lower birth weights (p=.04), lower AMS scores at 3 months (p=.004), 6 months (p = .009), 9 months (p<.001), post- operatively (p=.01), and at most recent follow-up (p =<.001), compared to white patients.
Conclusion:
This study demonstrates that socioeconomic context may impact OBPP management and outcomes. Our findings highlight the importance of regular follow-up and the reevaluation of resources available for those experiencing obstacles to care.
