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Motor vehicle transportation in hip spica casts: are our patients safely restrained?
Martin J Herman1, Joshua M Abzug, Evgeny E Krynetskiy
1Department of Orthopaedic Surgery, St Christopher's Hospital for Children, Philadelphia, PA 19134-1095, USA. martin1.herman@tenethealth.com
Insights
Many children in hip spica casts are not safely transported in vehicles. Improved hospital protocols and parental education are crucial for ensuring safe travel for these children.
Area of Science:
- Pediatric safety
- Orthopedic patient transport
- Motor vehicle accident prevention
Background:
- Motor vehicle safety is mandated by federal and state laws for all children.
- Hip spica casts are frequently used for pediatric orthopedic conditions.
- Safe transportation methods for children in hip spica casts require specific consideration.
Purpose of the Study:
- To identify current methods of motor vehicle restraint for children in hip spica casts.
- To assess the safety and adherence to recommendations for transporting children in hip spica casts.
- To evaluate the effectiveness of physical therapist recommendations for pediatric restraint devices.
Main Methods:
- A cohort of 31 children (35 casts) in hip spica casts were enrolled between 2006 and 2008.
- Physical therapists evaluated restraint needs and recommended transport methods (car seat, ambulance, specialized seat).
- Parental questionnaires assessed adherence to recommendations, transportation modes, and accident/violation occurrences.
Main Results:
- None of the children were recommended for standard car seats; 12 needed ambulance transport, 23 needed specialized car seats.
- Only 23% of children followed the initial physical therapist recommendations for safe transport.
- A significant majority (69%) of children in hip spica casts were transported suboptimally post-discharge.
Conclusions:
- Most children in hip spica casts are inadequately restrained during motor vehicle travel.
- Pediatric hospitals need enhanced strategies to improve adherence to safe transportation protocols.
- Potential solutions include improved parental education, insurance coverage expansion, and financial assistance programs.
Background:
Federal guidelines and state laws mandate that all children must be appropriately restrained while traveling in motor vehicles to reduce the risk of injury and death secondary to motor vehicle accidents. The purpose of this study is to identify the methods of restraint in motor vehicles for children in hip spica casts.
Methods:
Children placed in hip spica casts between August 1, 2006 and August 1, 2008 were recruited. Demographic data, type of spica cast placed, and reason for cast placement were recorded. Before discharge, all children were evaluated by a physical therapist to determine adequate restraint with the least cost. At each follow-up visit and at the time of cast removal, parents filled out standardized nonvalidated questionnaires to determine the method of restraint, mode of transportation, the approximate number of trips taken per week, and the occurrence of traffic violations or accidents.
Results:
Thirty-one children, average age of 5 years (range, 1.3 to 13 y), in a total of 35 spica casts were enrolled in the study. After evaluation by the physical therapist, none of the children were recommended to be transported in their personal car seat, 12 children were advised to travel by ambulance and 23 were advised to use a specially manufactured car seat. Overall, 8 of 35 children (23%) followed the initial recommendation of the physical therapist. On the basis of our discharge protocol's recommendations, children in 24 spica casts (69%) were suboptimally transported after discharge, 6 children who should have had ambulance transportation and 18 who should have been transported by a specially manufactured car seat.
Conclusions:
The majority of children in hip spica casts are not safely restrained when traveling in motor vehicles. Pediatric hospitals must develop better strategies to improve adherence to prescribed safe transportation protocols for patients in hip spica casts. Improved parental education, expansion of insurance coverage for restraints, hospital-based loaner programs and financial assistance to families are potential solutions to explore.
