Abstract:
Introduction/Background: Respiratory disease is the leading cause of death in children and young people with cerebral palsy however the onset of the disease onset is insidious and clinical care pathways for prevention and treatment are unclear. The aim of this study is to determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP).
Material and method: Design 3-year prospective cohort study using linked respiratory hospital admissions data for young people with CP, aged 1–26 years, who had previously provided self-reported and carer reported respiratory symptoms. The respiratory hospital admissions were defined by the International Statistical Classification of Diseases and Related Health Problems [ICD-10] codes. Incidence rate ratios (IRRs) were calculated for univariate and multivariate models.
Results: Four hundred and eighty-two participants (including 289 males) were recruited. They were aged 1 to 26 years (M 10 years, 10 months; SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS Level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastroesophageal reflux disease (GERD), at least 2 courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms, and nightly snoring.
Conclusion: Most risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness.