Neuromuscular Patients Are 40% More Likely to Get a Cast Injury

Area of Science:

• Orthopaedic surgery
• Pediatric care
• Patient safety

Background:

• Cast application, immobilization, and removal can lead to injuries like pressure ulcers and burns.
• The incidence of cast injuries in pediatric populations is not well-documented.
• Identifying modifiable risk factors is crucial for improving care quality.

Purpose of the Study:

• To quantify the incidence rate of cast injuries in a large pediatric orthopaedic practice.
• To identify risk factors associated with cast injuries in children.
• To inform quality improvement initiatives for cast care.

Main Methods:

• Retrospective review of pediatric patients (under 21) treated with casts between July 2019 and October 2020.
• Data collected included patient diagnosis, cast type, and cast applicator's training level.
• Injuries identified via cast technician documentation; incidence calculated per 1000 casts.

Main Results:

• Overall incidence of cast injuries was 12.5 per 1000 casts (28 injuries out of 2239 casts).
• Pressure ulcers accounted for 10.3 per 1000 casts, and cast saw burns for 2.2 per 1000.
• No significant correlation found between injury incidence and cast applicator's training level or timing of application.
• Patients with neuromuscular disorders had a significantly higher incidence of cast injuries (37.4 per 1000) compared to others (7.5 per 1000).

Conclusions:

• The incidence of cast injuries in this pediatric tertiary referral center is 12.5 per 1000.
• Cast applicator training and academic timing did not correlate with injury rates.
• Neuromuscular disorders represent a significant risk factor for cast-related injuries in children.