The incidence and implications of cerebral palsy following potentially avoidable obstetric complications: a preliminary burden of disease study.

OBJECTIVE: To determine the extent of cerebral palsy attributable to adverse obstetric events, and estimate the lifetime mortality and morbidity expectations of these individuals relative to age-matched members of the UK general population. DESIGN: Simulation model. SETTING UK POPULATION: All projected live births during 2014. METHODS: Using published data regarding the incidence and aetiology of cerebral palsy, we simulated the outcomes of a hypothetical cohort of UK live births. Survival and quality of life (QoL) for those with cerebral palsy were compared with age-matched individuals representative of the UK general population, in order to estimate the number of quality-adjusted life years (QALYs) lost following asphyxia-related cerebral palsy. MAIN OUTCOME MEASURES: Incidence of asphyxia-related cerebral palsy, QALYS, QoL, and survival. RESULTS: A total of 207 (95% CI 169-245) cases of asphyxia-related cerebral palsy were projected amongst UK children born during the year 2014, with approximately 15.2 QALYs lost per case. If these results held true in a real birth cohort, 3142 (95% CI 2321-3963) QALYs would be lost as a consequence of asphyxia-related cerebral palsy, a loss valued by the UK National Health Service at £62.9 m (95% CI £46.4-79.3 m). CONCLUSIONS: Cerebral palsy following intrapartum asphyxiation leads to significant reductions in QoL and survival; however, this may often be prevented. For those with GMFCS 1 and GMFCS 2 cerebral palsy (Gross Motor Function Classification System), lifetime QALYs accrued largely resemble those experienced by the UK general population, whereas for GMFCS 3 and GMFCS 4 QALYs are reduced considerably, and are negative in the case of GMFCS 5.

The advanced life support group's view of HOSPEX.

This paper explores some of the principles and intentions behind simulation in medical education and explores the extent to which HOSPEX fits within an accepted design. It further points to the direction that HOSPEX will need to take in order to maximise its capacity to aid the delivery of exemplary patient safety.