{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T21:30:34Z","timestamp":1773091834686,"version":"3.50.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kaohsiung Armed Forces General Hospital Research Foundation","award":["KAFGH-A-110011"],"award-info":[{"award-number":["KAFGH-A-110011"]}]},{"name":"Tri-Service General Hospital Research Foundation","award":["TSGH-B-110012"],"award-info":[{"award-number":["TSGH-B-110012"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objectives<\/jats:title><jats:p>To investigate the effect of botulinum toxin A (BTA) on the development of hip dislocation and scoliosis, surgical rates for hip and spine, and mortality in cerebral palsy (CP).<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Study design<\/jats:title><jats:p>A cohort study was conducted using CP data from a Taiwan National Insurance Health Research Database. Diagnoses were defined using the International Classification of Diseases codes, 9th revision. Adjusted hazard ratios for outcomes were calculated using Cox regression analysis and adjusted for the following variables: BTA injection, sex, age, severities of CP, comorbidities, location, urbanization level, and level of care.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>A total of 1,405 CP children (670 female vs. 735 male), 281 in the BTA group and 1,124 in the controls, were followed-up for a mean of 5 years 4 months. There were no significant differences in the outcomes in both groups, in the incidence rates of hip dislocation and scoliosis, nor in the surgical rates for hip and spine surgery. Mortality rate in the BTA group was 0.49 times lower than that in the controls (<jats:italic>p<\/jats:italic>= 0.001). Moderate to severe types of CP had higher incidence rates of hip dislocation, scoliosis, hip surgery, spine surgery, and mortality.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Moderate to severe types of CP had poorer outcomes in all aspects, including a higher risk of hip dislocation, scoliosis, surgical rate for hip and spine, and mortality. Although BTA injection in children with CP proved to not significantly reduce hip dislocation and scoliosis, it is considered safe as an anti-spasticity treatment and may be beneficial for survival.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0255143","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T17:53:41Z","timestamp":1626976421000},"page":"e0255143","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Long-term effect of botulinum toxin A on the hip and spine in cerebral palsy: A national retrospective cohort study in Taiwan"],"prefix":"10.1371","volume":"16","author":[{"given":"Ching-Yueh","family":"Lin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-9900","authenticated-orcid":true,"given":"Chi-Hsiang","family":"Chung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis J.","family":"Matthews","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heng-Yi","family":"Chu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang-Cheng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sung-Sen","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3286-0780","authenticated-orcid":true,"given":"Wu-Chien","family":"Chien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"issue":"9924","key":"pone.0255143.ref001","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/S0140-6736(13)61835-8","article-title":"Cerebral palsy","volume":"383","author":"A Colver","year":"2014","journal-title":"Lancet"},{"issue":"4","key":"pone.0255143.ref002","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/01202412-200507000-00007","article-title":"Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity","volume":"14","author":"G Hagglund","year":"2005","journal-title":"J Pediatr Orthop B"},{"issue":"Suppl 5","key":"pone.0255143.ref003","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1046\/j.1468-1331.2001.00043.x","article-title":"The effect of botulinum toxin type A and a variable hip abduction orthosis on gross motor function: a randomized controlled trial","volume":"8","author":"RN Boyd","year":"2001","journal-title":"Eur J Neurol"},{"issue":"1","key":"pone.0255143.ref004","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2106\/JBJS.F.01416","article-title":"Does botulinum toxin a combined with bracing prevent hip displacement in children with cerebral palsy and \"hips at risk\"? 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