Inconsistent, conflicting surgical recommendations for patients with cerebral palsy (CP) are challenging for both physicians and parents. A team at Cincinnati Children’s led by orthopaedic surgeon James J. McCarthy, MD, MHCM, wants to end the confusion and create standardized guidelines to improve care for this patient population.

Over the past year, McCarthy, director of the Division of Orthopaedics, has formed a panel of experts from 15 institutions around the world. Their objective is to successfully develop guidelines using a combination of best available evidence and expert opinion to establish consensus.

“Currently there is a lot of variability with the surgical recommendations for patients with CP,” McCarthy explains. “You can have different doctors evaluate the same patient’s physical exam and history, and that child can receive multiple different recommendations on how to proceed with their surgical care options.” For parents receiving second opinions for their child, those differing recommendations can be overwhelming.

This research team is attempting to alleviate some of that confusion. Each expert provides their perspective on indications for surgery. Their goal is to build consensus among the group. They are using a proven method, the RAND-UCLA Appropriateness Method, which combines scientific evidence with expert opinion. The end result will be guidelines that outline a procedure’s appropriateness based on patient-specific symptoms, medical history and test results.

Responding to a Family’s Frustration

“The original spark for this work came when I saw a patient who had been to a couple of other well-known institutions and had received highly disparate treatment recommendations,” McCarthy says. “The family had been told multiple different things. They were frustrated, and I was frustrated for them.”

The team has thus far identified a group of procedures and how to classify indications. McCarthy says the preliminary results are promising. A paper discussing the surgical indications for hamstring lengthening and femoral derotational osteotomy is currently in review.

“This work has the potential to profoundly impact the surgical care of kids with cerebral palsy,” McCarthy says. The team’s guidelines should prevent unnecessary surgeries, reduce costs for these families and improve the quality of care.

Although the initial goal is to create standards for this complex patient population, the team has even higher hopes. They believe the research will serve as a foundation for future efforts to standardize surgical recommendations nationally and lead to evaluation of long-term outcomes.

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