King's College London

Aim: To ascertain the association between Magnetic Resonance Imaging Classification System (MRICS) categorization and burden of acute, emergency hospital admissions amongst children with cerebral palsy (CP). Method: Data in the National Health Service organization’s secure data repository from 1987 to 2016 were interrogated, augmented from medical records, and analysed. Descriptive and multivariate analyses were completed. Results: Of the 312 children with CP born between 1987 and 2015, 217 shared 1433 acute hospital admissions across 5092 days; 30.4% had no acute admissions, amongst whom Gross Motor Function Classification System (GMFCS) levels I to III, absence of tube-feeding, and MRICS B1 together appeared protective. MRICS A1, B3, and C1 were associated with higher burdens of acute admissions on multivariate analysis. The 24 out of 312 (7.69%) children who died shared 490 out of 1433 (34.19%) acute admissions over 2034 out of 5092 (39.95%) inpatient days amongst all children with CP. The 4 out of 24 with MRICS B3 who died shared 12.63% acute admissions overall and 31.03% of all respiratory admissions in the 5 to less than 10 years age group. Interpretation: Comprehensive assessment of children with CP, including use of validated scales of function and magnetic resonance imaging findings, can inform discussions with families about potential burden of hospital admissions and possibly also risk of early death. This can provide context for shared decision-making about interventions. Longitudinal ‘big data’ can illuminate patterns and promote studies into potential causes of change. What this paper adds: More than one-third of children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels I to III required no acute hospital admissions. Magnetic Resonance Imaging Classification System (MRICS) categories A1, B3, and C1 appear to be linked with higher burdens of inpatient days. MRICS category B1 in children with CP in GMFCS levels I to III appeared to lessen the risk of admissions. MRICS B3 may be a risk factor for premature death in children with CP, especially aged >5 years with higher rates of acute respiratory admissions. All children with clinical CP should be offered neuroimaging to inform prognostication.