Frequency and nature of comorbid diagnoses in children with cerebral palsy: a register-based study: American Academy for Cerebral Palsy and Developmental Medicine Annual Meeting

Background and objectives
In addition to the motor impairments that define cerebral palsy (CP), children with the condition may experience other diagnoses that may be associated with CP, or be unrelated to the condition. These diagnoses will impact on the child’s health and social care requirements. Using an established population-based register, this study aimed to describe (i) the frequency and nature of comorbid diagnoses reported in children with CP and (ii) trends in reported comorbidities over time. 

Study design
Population-based register study.

Study participants and setting
The sample comprised 1,895 cases notified to the Northern Ireland CP Register (NICPR), born 1981-2011, with congenital or acquired CP.

Materials / Methods
The NICPR uses multiple and overlapping sources of ascertainment. Each notified case is followed up: a standardised assessment booklet is completed by a clinician known to the child and the booklet subsequently validated by the NICPR’s paediatrician after the child’s fourth birthday. In this study ‘free text’ data fields related to congenital malformations, other diagnoses and syndromes were examined and data categorised according to the body system affected. The frequency and nature of reported comorbid diagnoses were summarised using descriptive statistics. The proportions of children reported as having one or more comorbid diagnoses were graphed by birth year and visually inspected. 

Results
Almost two-thirds (n=1206; 63.6%) of cases had no reported comorbidities at the time of confirmation on the NICPR. Of the remaining 689 children, almost half (n=300; 43.5%) had more than one reported comorbidity. The most commonly reported comorbidities were associated with the nervous (n=249), respiratory (n=166) and cardiac (n=99) systems. Less commonly reported comorbidities involved the endocrine (n=12) and musculoskeletal (n=40) systems. Visual inspection of the proportion of cases reported having one or more comorbid diagnoses demonstrated an increasing trend over time, from approximately one in five cases in 1981 to approximately half of cases in 2011.

Conclusion / Significance
A significant proportion of children with CP in Northern Ireland had additional reported comorbid diagnoses. The increase in the proportion of cases with reported comorbidities in recent years warrants further investigation: it may represent increased complexity of cases, improved diagnostic capabilities, or better/more complete reporting. Nonetheless, these data provide an indication of the range of clinical services required to address the complex healthcare needs of this population. This information may help with future service planning and provision.