Collins Angela C, Caskey Sean, Peck Jeffrey B, Walter Norman, Atkinson Theresa S, Atkinson Patrick J
Department of Orthopaedic Surgery, McLaren Regional Medical Center.
Texas Scottish Rite Hospital for Children, Dallas, TX.
J Pediatr Orthop. 2020 May/Jun;40(5):e394-e400. doi: 10.1097/BPO.0000000000001477.
There is a paucity of data defining safe transport protocols for children treated with hip spica casting. Although restraint devices for casted children are available, all federally mandated testing uses a noncasted anthropomorphic test device (ATD or crash dummy). The purpose of this study was to evaluate current restraint options in simulated frontal crash testing using a casted pediatric ATD to determine injury risk to the head, cervical spine, chest, and pelvis.
Using a 3-year-old ATD, dynamic crash sled tests simulating frontal crash were performed in accordance with government safety standards. The ATD was casted in a double-leg spica and the following restraint devices were tested: a seat designed for spica casted children, a restraint vest-harness, a traditional booster seat, and 2 traditional forward-facing car seats.
Although the presence of the cast increased many of the injury metrics measured, all seats passed current federal guidelines for the head and chest. No single seat performed best in all metrics. The greatest magnitude of neck loading and second-highest head injury criterion values were observed for the booster seat. The vest-harness produced the highest head injury criterion and the chest compression exceeded proposed federal limits.
The results suggest safe transport in commercially available seats is possible with the child properly restrained in a correctly fitting seat. However, parents should not assume a child restraint system is appropriate for use just based on fit as, for example, seats with harnesses outperformed an easy to fit booster seat.
Each child and the position of the child's cast are unique and discharge planning involves consideration of safe transportation. Although this study suggests several seats used to transport spica casted children pass the federal head and chest injury prevention requirements, it is important to recognize that some children may still require emergency vehicle transport.
关于髋人字石膏固定治疗儿童的安全运输协议，相关数据匮乏。虽然有适用于石膏固定儿童的约束装置，但所有联邦规定的测试都使用未打石膏的人体模型测试装置（ATD或碰撞假人）。本研究的目的是使用打石膏的儿科ATD评估模拟正面碰撞测试中的当前约束选项，以确定头部、颈椎、胸部和骨盆的受伤风险。
使用3岁的ATD，按照政府安全标准进行模拟正面碰撞的动态碰撞雪橇测试。ATD被固定在双腿髋人字石膏中，并测试以下约束装置：专为髋人字石膏固定儿童设计的座椅、约束背心安全带、传统增高座椅和2个传统前向汽车座椅。
虽然石膏的存在增加了许多测量的损伤指标，但所有座椅都通过了当前关于头部和胸部的联邦指导方针。没有一个座椅在所有指标上表现最佳。增高座椅的颈部负荷最大，头部损伤标准值第二高。背心安全带产生的头部损伤标准最高，胸部压缩超过了联邦提议的限制。
结果表明，将儿童正确约束在合适的座椅中，使用市售座椅进行安全运输是可行的。然而，家长不应仅仅基于尺寸合适就认为儿童约束系统适合使用，例如，带有安全带的座椅比易于安装的增高座椅表现更好。
每个儿童及其石膏的位置都是独特的，出院计划需要考虑安全运输。虽然这项研究表明，用于运输髋人字石膏固定儿童的几种座椅通过了联邦头部和胸部损伤预防要求，但重要的是要认识到，一些儿童可能仍需要紧急车辆运输。
