Herman Martin J, Abzug Joshua M, Krynetskiy Evgeny E, Guzzardo Leah V
Department of Orthopaedic Surgery, St Christopher's Hospital for Children, Philadelphia, PA 19134-1095, USA.
J Pediatr Orthop. 2011 Jun;31(4):465-8. doi: 10.1097/BPO.0b013e31821996b2.
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.
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.
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.
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.
联邦指南和州法律规定，所有儿童在乘坐机动车时必须得到适当约束，以降低因机动车事故导致受伤和死亡的风险。本研究的目的是确定髋人字石膏固定患儿乘坐机动车时的约束方法。
招募2006年8月1日至2008年8月1日期间接受髋人字石膏固定的儿童。记录人口统计学数据、石膏类型及固定原因。出院前，由物理治疗师对所有儿童进行评估，以确定成本最低的适当约束方式。在每次随访及拆除石膏时，家长填写标准化的非验证问卷，以确定约束方法、交通方式、每周出行次数及交通违规或事故发生情况。
共纳入31名儿童，平均年龄5岁（范围1.3至13岁），共35个髋人字石膏。经物理治疗师评估后，没有儿童被建议使用其个人汽车座椅出行，12名儿童被建议乘坐救护车，23名儿童被建议使用特制汽车座椅。总体而言，35名儿童中有8名（23%）遵循了物理治疗师的初始建议。根据我们出院方案的建议，24个髋人字石膏固定的儿童（69%）出院后交通方式欠佳，其中6名儿童本应乘坐救护车，18名儿童本应使用特制汽车座椅。
大多数髋人字石膏固定的儿童在乘坐机动车时未得到安全约束。儿科医院必须制定更好的策略，以提高髋人字石膏固定患者对规定安全交通方案的依从性。改善家长教育、扩大约束装置保险覆盖范围、医院出借计划以及向家庭提供经济援助都是值得探索的潜在解决方案。
