United Brachial Plexus Network, Inc.

I found a website http://hcupnet.ahrq.gov/

You can track rates of diagnosis (767.6=OBPI) and (953.4=TBPI).

They use inpatient coding versus the outpatient coding. Accuracy is only as reliable as the reporting, but hospitals are looking to make money and coding is how they are able to bill (I think)

. The number of TBPI has been fairly consistent-about ~1900 new injuries every year between 1997-2005

The other thing to note is in three of the years, I could break down the TBPI to separate for injuries at 0-17 age group and others

age 0-17 other
1997 237 1860

2000 210 1850

2003 240 1781


For OBPI I took the raw data and calculated the table for an injury rate.

The rate has decreased as the number of c-sections has increased debunking the bullshit that the rate has remained unchanged.

I always wondered why they said that, how could it be? Well in fact based on this data anyway, it isn't true. The rate has slowly decreased.

while the rate of c-section went up 50% (comparing 1997-199 vs 2003-2005) the rate of injury decreased 26.4 %(comparing 1997-1999 vs 2003-2005)!!!

We all know sections are done for myriad of reasons, but it does stand to reason that some OBPI are spared and this proves it--

Year births/yr c-sec/yr C-sec.rate OBPI Vag births OBPI/1000 vag births
1997 3882000 730459 0.188165636 6750 3151541 2.141809356
1998 3941553 726227 0.18424895 7226 3215326 2.247361543
1999 3959417 781796 0.197452302 7459 3177621 2.34735357
2000 4058814 876142 0.215861579 6571 3182672 2.064617403
2001 4025933 928199 0.230555004 6143 3097734 1.983062458
2002 4021726 1031457 0.256471227 6828 2990269 2.28340661
2003 4089950 1099047 0.268718933 5620 2990903 1.879031182
2004 4112052 1189048 0.289161713 5306 2923004 1.815255812
2005 4138349 1224925 0.295993644 4856 2913424 1.66676735
total 4025532.667 954144.4444 0.23629211 6306.556 3071388.222 2.047629476


rich

This information is extremely interested based upon the fact that I have been told several times that even with a section, my son's injury would have prob. still occured. I mean, at this point there's no way of knowing but it does appear that sections greatly reduce the chances of injury and that's worth something.

Thanks for sharing. I would be surprised if there was no decrease in the numbers due to the increased c-section rate.

Speaking for myself I would without a doubt and hesitation have a c-section if I was to have another child. I know it is not easy but neither is caring for a child with OBPI. We can recover from a c-section in a few months but what about our children who have bpi? It is lifelong and often is cause for them to undergo surgery primary or secondary. What about their recovery? Thats just me. It is more painful to see my child suffer than to have to live with a more difficult recovery from a c-section. All situations are different. We have to live with our own decisions and therefore it is very personal. Good luck and God Bless to all struggling with these decisions in a time where there is not much guidance. We need to be our own and our children's advocates.

I know these are hard decisions.

The c-section rate has gradually increased. The vaginal birth rate has gradually decreased.

The OBPI rate, as shown here, has been all over the place. You could perhaps plot a trendline on the data but the variance would be huge. Just look at 2002 to 2003. Almost the exact same numbers of vaginal births, yet a huge drop in OBPI. What happened?

Kate

Well This is weighted data from only certain states that participate. There are several papers that write that codeing hospital data isn't 100% reliable. But I think it shows a general trend, which contradicts what most papers say, that it hasn't changed in 30 years, and that the increase in C-section rate hasn't affected the # of injuries. Clearly it has over the 9 year period from this data. We could definitely write a paper using this data, as well as outpatient data, and refute some of the bull that they have written about incidence. They use this data as well, but manipulate it..

rich

Rich,

For two sets of data to be correlated, they need to have *more* than just the same general trendlines. For instance, the "bumps" up and down in the OBPI rate would have to correspond to similar bumps in the c-section data, and they just don't. I ran some very basic statistics on excel, and the correlation simply isn't very strong at all. Here are the correlation coefficients in the data (-1 < p < 1 where p=1 means perfectly directly correlated and p=-1 means perfectly inversely correlated).

p= -.8375 (OBPI total to total births)
p= 0.8412 (OBPI total to Vag birth)
p= -.8887 (OBPI total to c-section births)

p= -0.7947 (OBPIs/1000 births to total births)
p= -0.7963 (OBPIs/1000 births to c-section births)
p= 0.7721 (OBPIs/1000 births to vag births)

For comparison, the correlation coefficients for OBPIs to YEAR or OBPIs/1000 vag births to YEAR) are

p= -0.8608 (OBPI total to Gregorian Calendar Year)
p= -0.7741 (OBPIs/1000 births to Gregorian Calendar Year)

Obviously the correlation to year is silly; I put it there to make a point. Both the total number of OBPIs and the rate of OBPIs are MORE CORRELATED to what year it is than how many vaginal births happened that year! Obviously there is something else affecting OBPI rates that isn't in this data. But the conclusion that the increasing c-section rate is what is causing less (reported) OBPIs just does not hold up from these numbers.

Sorry, I really wish there was an easy answer, like c-sections for everyone. But I don't think the answer is nearly as easy as that, and I would hate for universal C-sections to be promoted as a panacea based on statistics that just are not there.

Kate


Message was edited by: katep

Oh goodness, I wouldn't promote c-sections over training for delivery. I just think many docs publish data based on historical data such as this without justifying like you did. The general trends correlate so that is good enough for them. I am not a stat guy, nor I pretend to be, even trying to do stats on data that is admittingly partial, is silly, but at least there is another resource to attempt tracking injury.

for me, and that is all the data I have, it is clear! If I were given a section, I am positive that bpi would not have happened. the fact is he was a large baby that got stuck. if a section was given i would bet my life i would still have never heard of bpi. it is great that data is being done. whether one agrees with the result or not awareness to bpi is increasing.