Life expectancy and its adjustment in cerebral palsy with severe impairment: Are we doing this right?

Abstract

Life expectancy and its adjustment in cerebral palsy with severe impairment: Are we doing this right? In children with very severe cerebral palsy, an adversarial legal process for medical negligence, when liability is admitted, requires an estimate of life expectancy. Medical experts using the same cohort data and the same clinical facts can produce quite different life expectancies, leading to arguments in legal conferences and courts. The issues that commonly arise include between‐country comparisons, projected and therapy‐induced advanced life expectancies, and the contribution of epilepsy, scoliosis, and especially cognition to life expectancy. In this review, these factors are discussed from an arithmetic, statistical, and medical viewpoint to initiate debate on the issue, including whether median survival should be advocated.

Mortality after spinal fusion in children with cerebral palsy and cerebral‐palsy‐like conditions: A 30‐year follow‐up study

“…The primary goal of this paper is to provide information for decision making related to survival probability after scoliosis correction in children with CP; however, there is substantial interest in predicting survival probability for medical liability cases. A review of the data by Rosenthal 38 noted that there are no data about the impact of scoliosis on survival probability; however, the impacts of seizures and gastrostomy tubes that he noted are similar to those reported in the current study. One limitation of this series is the assumption that patients not confirmed to have died, by a search of the National Death Index through the Centers for Disease Control, were assumed to be alive.…”

Life expectancy in cerebral palsy and its importance in modern law

“…Since then, there have been notable improvements concerning all aspects of quantification of future losses. Rosenthal’s paper shows that courts and insurance companies now rely on more accurate data concerning the life expectancy of severely injured children 4 . But trying to determine at what age an individual person will die remains largely guesswork.…”

Life expectancy in cerebral palsy litigation: What constitutes an expert opinion?

“…EDITOR-We are two of the authors of a number of the papers cited by Rosenthal in his invited review, 1 and we have each provided expert opinions on life expectancy on many occasions in various jurisdictions including the UK. We therefore believe that we can offer a reasoned perspective on his main question: 'Are we doing it right?'…”