Long-term motor outcome analysis using a motor score composite following surgical brachial plexus repair

Object. Due to the complex and variable nature of brachial plexus injury, outcome analysis can be cumbersome and imprecise. Many scales have been devised, but no single scale is used uniformly. Moreover, despite several studies in which the authors have reported brachial plexus surgical data, no highly predictive clinical model has been defined. Methods. In this study the authors performed a retrospective analysis of 114 consecutive brachial plexus surgeries performed by the senior author during the past 14 years at St. Louis Children's Hospital. Of these, 63 are included in this study. The authors defined the motor score composite (MSC) and used this novel metric to perform a detailed analysis of their surgical outcomes. The mean MSC was 0.50 preoperatively, 0.71 at 1 year postoperatively, and 0.80 at 2 years postoperatively. By 2 years postoperatively, 89% of the patients attained a good or excellent recovery. Age at surgery, time to visit, location, and severity were predictive of outcome. Using MSC data, the authors developed a prognostic model that enabled the prediction (with 88% accuracy) of surgical outcomes using preoperative variables. Conclusions. The MSC is an efficient metric for the reporting of data regarding outcomes of brachial plexus injury. It provides information about extent and severity of injury in a single proportion and facilitates complex data analysis. The authors used the MSC model to accurately predict surgical outcome. This metric could have wide applicability for the prediction of postoperative recovery to improve both surgical decision making and family counseling.