Mapping Population-Level Differences in Brachial Plexus Birth Injury: An International Meta-Analysis

PURPOSE: The majority of brachial plexus birth injuries (BPBI) occur without prenatally identifiable risk factors. This meta-analysis mapped BPBI incidence worldwide as a preliminary step toward investigating population-level predictors. METHODS: This systematic review searched PubMed, Embase, Cochrane, and Web of Science. Eligible studies provided cross-sectional data on BPBI incidence without inclusion criteria predicated on known risk factors. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers screened studies, extracted data, and assessed risk of bias. Meta-analyses of proportions were conducted using random-effects models to estimate composite international incidence; covariates were incorporated with meta-regressions to compare population-based differences. RESULTS: Reviewers screened 1,245 studies; 116 were included, and 91 were eligible for meta-analyses. The review identified gaps in the literature regarding Central American, South American, African, and Northeast Asian epidemiology. Acknowledging these limitations, 71.5 million live births across 30 countries in all 6 populated continents were pooled for meta-analyses to estimate composite international incidence and population-level variation. Composite BPBI incidence was 1.4 per thousand births (95% confidence interval, 1.3-1.6), yet estimates from individual countries ranged from 0.4 to 4.6 per thousand births. Meta-regression confirmed significant international differences in BPBI incidence; country of birth explained 34.2% of between-study variance. From studies that tracked permanent BPBI, 18.4% (95% confidence interval, 15.3% to 22.0%) of cases persisted beyond a year. CONCLUSIONS: These findings encourage the formulation of new research questions that may allow us to address the remaining unpredictability in BPBI incidence. Significant regional variation warrants exploration of population-level influences, including health-systems-level, environmental, or sociodemographic factors, along with unexplored individual-level factors such as genetic contributions. TYPE OF STUDY/LEVEL OF EVIDENCE: Symptom prevalence study 2a.