ABSTRACT
PURPOSE: Evaluation of patients with cerebral palsy is complex and variable. Several examinations, including video analysis, are necessary as part of the surgical planning process. Videotaped evaluation of the upper extremity in children with cerebral palsy has been used as an objective assessment of functional ability and deformity. The effect of review of these videotaped evaluations on altering the initially proposed surgical plan has not been evaluated. METHODS: This is a retrospective study completed through a chart review. Inclusion criteria were all patients with cerebral palsy having upper extremity surgical consultation with the primary investigator (M.G.C.) between 1995 and 2005, having at least 2 presurgical consultations, completing a videotaped evaluation, and proceeding to surgery. Of 167 new patients, 94 patients, having 430 procedures, were eligible for the study. Five distinct anatomical areas (elbow, forearm, wrist, digit, and thumb) were delineated. RESULTS: Changes to the initial surgical plan based on a review of the videotaped evaluation were made for 77 patients (138 procedures) and carried through to surgery for 68 patients (108 procedures). Those procedure changes that carried through to surgery most often involved the thumb, wrist, and digit, as compared to the elbow and forearm. CONCLUSIONS: Videotaping evaluations allows for more precise understanding of ability and improves diagnosis. Changes to the initial presurgical plan were made in 77 patients (72%) after videotaped evaluation, most commonly for procedures addressing the wrist, digit, and thumb.
Subject(s)
Cerebral Palsy/pathology , Elbow Joint , Hand Joints , Joint Deformities, Acquired/surgery , Orthopedic Procedures , Videotape Recording , Adolescent , Adult , Cerebral Palsy/physiopathology , Cerebral Palsy/surgery , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Male , Middle Aged , Patient Selection , Physical Examination , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Weight gain and increase in B-Type Natriuretic Peptide have been advocated as means of aiding diagnosis of heart failure. However, there are few data to support the use of these criteria in diagnosing clinical deterioration in patients with established disease. AIMS: This prospective study examines the sensitivity and specificity of absolute and relative changes in BNP and weight in determining the early onset of clinical deterioration in patients with established heart failure. METHODS: All patients who presented to the outpatient clinic with completed self-reported daily weight books, baseline BNP measurement, outpatient BNP measurement and assessment by a cardiologist blinded to BNP and weight were included. Each patient was determined as clinically stable (CS) or in clinical deterioration (CD). Receiver operating characteristic (ROC) curves and sensitivity and specificity calculations for various absolute and relative BNP and weight changes were carried out. RESULTS: Weight and BNP changes were examined in 34 CS presentations (mean age 69.5+/-16.1 years) and 43 CD presentations (mean age 70.0+/-10.6 years). ROC analysis demonstrated that neither weight nor BNP changes in absolute or relative values predicted clinical deterioration in this study population adequately (AUC values ranging from 0.64 to 0.66). CONCLUSIONS: These data demonstrate that increase in body weight and BNP in isolation are not sensitive in assessing clinical deterioration in established heart failure. These observations may need to be emphasized in patient education and to physicians involved in assessment of heart failure patients.
