Clinical, electrophysiological, and imaging findings in childhood brachial plexus injury.
Katherin E Portwood, Mehmet S Albayram, Sarah Stone and 4 others
PMID 35524644WHAT IT FOUND
MRI nerve root scores and EMG denervation scores identified participants who needed surgery at some thresholds among 21 participants with brachial plexus injury.
Nerve conduction amplitudes did not predict surgery.
Key findings
01For BPBI participants, MRI scores lower than 2 at C7 and C8 were present in both surgical participants; for postneonatal BPI participants, MRI scores of 2 or lower at C7 were present in all three surgical participants.
02An average denervation score of 1 or less for any nerve root had a 100% positive predictive value for surgery in BPBI and postneonatal BPI, and a composite MRI plus EMG score of 3 or less had a 100% positive predictive value for surgery in both groups.
03Neither sensory nor motor nerve conduction amplitudes were prognostic of the need for surgery.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study included 21 participants, including eight with postneonatal BPI, so the surgical prediction numbers may not generalize. AMS scores were collected retrospectively, which limited the number available for analysis. The study used the clinical decision to operate as the outcome, and the authors noted surgical decisions can introduce confounding and may not always reflect injury severity. Sensory and motor nerve conduction data for higher root levels were missing, so comparisons between nerve conduction and EMG cannot be settled. Only two surgical participants had longitudinal AMS data, so the AMS surgical course is described for a very small number of children. MRI T1 roots were not scored, and the MRI studies spanned 2005 to 2019, which may limit consistency.
The easy way to misread this
Do not read the 100% positive predictive values as proof that MRI or EMG alone can decide surgery. The study had 21 participants, and some thresholds were based on both surgical BPBI participants or all three surgical postneonatal participants. The outcome was the clinical decision to operate, not a tested treatment effect.