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The influence of socioeconomic factors on the prognosis of brachial plexus birth injury
Erin Meisel, MD
1; Nathan Khabyeh-Hasbani, BA
2; Brittany Lala, MD
2; Emily Ferreri, BS
2; Mandana Behbahani, MD
2; Steven M. Koehler, M.D.
21Children's Hospital Los Angeles, Los Angeles, CA; 2Montefiore Medical Center, Bronx, NY
Introduction: This study aims to evaluate the influence of socioeconomic backgrounds on the prognosis and of the factors associated in infants diagnosed with a brachial plexus birth injury (BPBI).
Methods: Patients diagnosed with a BPBI between November 2021 and November 2023 within a singular healthcare system in the United States were prospectively included in the study. Demographic data, birth history, outcome scores, and operative reports were collected. Stratification of patients based on socioeconomic background utilized the Child Opportunity Index (COI), in which scores were assigned based on nationally normed ZIP code-level data, with a lower COI score signifying a lower childhood opportunity. Statistical analysis employed multivariate analysis, with a predefined significance level of p < 0.05.
Results: Out of 107 patients with a diagnosis of BPBI, 75 met the inclusion criteria. Patients were initially seen at the brachial plexus clinic at a mean age of 70 (SD 110) days with 24% of patients' guardians being non-English speaking, requiring the use of an interpreter. A majority of patients had evidence of shoulder dystocia (72%), were firstborn (30%) via vaginal delivery (88%), were not macrosomic (75%) and experienced at least one complication during pregnancy, labor, or delivery (89%). Those with persistent symptoms following birth, 68.6% required therapy, 35.3% required surgery, and 56.8% had a secondary diagnosis of glenohumeral dysplasia. When nationally-normed for the education domain, the health and environment domain, the social and economic domain, and the overall child opportunity index, the mean percentiles were, 25.3 (SD 28.2), 64.5 (SD 12.0), 16.3 (SD 27.2), and 18.6 (SD 27.4), respectively. At the national level, there was a significant correlation between worse health and environmental quality and a more severe BPBI diagnosis (p = 0.007). However, there was no other significant correlation determined between the prognosis of BPBI and overall socioeconomic status.
Conclusion: Although a significant correlation was found between a more severe diagnosis of BPBI and a lower health and environmental score, the prognosis and associative risk factors were not correlated with a lower overall socioeconomic status. Regardless of socioeconomic status, our findings demonstrate that patients will have similar outcomes when appropriately managed. Our findings underscore the need for an extensive national investigation of socioeconomic factors associated with those diagnosed with BPBI.
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