Validity of accelerometry to measure physical activity in children and adolescents with an acquired brain injury

Background/Objectives: Pediatric intrathecal baclofen pump infection rates of 4% to 21% have been reported in the literature. A majority of pump infections have been shown to be surgically acquired. It is necessary to refill baclofen pumps on a scheduled basis which is an invasive procedure performed with aseptic technique. Evidence for infection related to baclofen pump refills is underreported in the literature. Study Design: A retrospective chart review of all patients undergoing placement of intrathecal baclofen pump at Cook Children’s Medical Center as a quality improvement initiative. Study Participants and Setting: The study period spans 16 years from program inception in 1998 through December 2014 and includes all patients undergoing placement or replacement of intrathecal pumps. Materials/Methods: Patients with pump infections were identified, and sorted with regard to timing and etiology of infection. Three experienced pediatric neurosurgeons are responsible for all pump surgeries. The institutional practice is to train and keep a small, dedicated number of personnel including physicians, a clinical nurse specialist, and nurse practitioners prepared to refill the pumps following aseptic precautions either in a clinic or inpatient setting. Training for refills is provided from a single individual initially with ongoing monitoring of trainees performing refill procedures for several months. Two people are usually present during the refill. Results: Two hundred seventy-five pumps have been placed during the 16 year study period (mean 10.6 per year). There were 195 initial placements and 80 pump replacements. Mean age at implant was 10 years. Cerebral palsy was the most common indication for implant (n=135; 69%). A total of 14 pump infections in 13 patients occurred during this period, an overall infection rate of 5%. One patient with chronic cellulitis had 2 separate explants for infection at days 15 and 57 post pump placements. Seven patients with cerebral palsy developed an infection (5.2%) and did not differ from the entire cohort. Mean age of all patients with infection is 10.1 years. Excluding two late infections (122 and 964 days from implant) that occurred in the context of chronic cellulitis, mean duration from implant to identification of infection is 20 days Six pumps were re-implanted after infection was treated with a mean interval of 238 days. Seven families opted not to have pump re-implanted. One patient with an acquired post-infectious dystonia had resolution of symptoms and ITB was no longer deemed appropriate. Conclusions/Significance: Most (71%) ITB pump infections occured within 36 days of implantation and could be attributed to surgical infection. Late infections (n=3) were noted in only 1% of patients, and were all attributable to external factors. No infections could be related to refill procedure. ITB pump management done by a dedicated group under controlled circumstances can be done safely in the pediatric population with a minimal risk of infection. SP5 Validity of accelerometry to measure physical activity in children and adolescents with an acquired brain injury E BAQUE, L BARBER, L SAKZEWSKI, R BOYD The University of Queensland, Brisbane, Qld, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Qld, Australia