Parker K, Miles S H
Department of Geriatric Medicine, St. Paul Ramsey Medical Center, Minnesota, USA.
J Am Geriatr Soc. 1997 Jul;45(7):797-802. doi: 10.1111/j.1532-5415.1997.tb01504.x.
To determine how bedrails cause death in order to suggest clinical and ergonomic changes to prevent such deaths and to promote research to improve the use and design of bed systems.
A review of reports of adult deaths and injuries from bedrails contained in the United States Consumer Product Safety Commission Death Certificate File and its Reported Incidents File and its National Injury Information Clearinghouse Accident Investigations from 1993 to 1996. Deaths involving the use of vest restraints were excluded. We reconstructed, reenacted, and have graphically depicted major patterns of deaths. A review of the literature to 1966 was also done.
The 74 deaths described are categorized into three types: (1) 70% were entrapments between the mattress and a rail so that the face was pressed against the mattress, (2) 18% were entrapment and compression of the neck within the rails, and (3) 12% were deaths caused by being trapped by the rails after sliding partially off the bed and having the neck flexed or the chest compressed.
Deaths from bedrails are underrecognized and preventable clinical events that can occur in any medical setting. Preventing these events will require a unified redesign of the relationships between rails, mattresses, and beds, which are now often assembled and used as separate products. Clinicians can prevent many of these deaths by using bedrails much more judiciously, confirming the proper relationships between beds, rails and mattresses, and using alarms.
确定床栏导致死亡的方式，以提出临床和人体工程学方面的改进建议，防止此类死亡事件发生，并推动相关研究，以改善床系统的使用和设计。
回顾1993年至1996年美国消费品安全委员会死亡证明档案、事故报告档案及其国家伤害信息交换中心事故调查中包含的成人因床栏导致死亡和受伤的报告。排除涉及使用背心约束带的死亡案例。我们对主要死亡模式进行了重构、重演并以图形方式呈现。还对1966年以前的文献进行了回顾。
所描述的74例死亡案例分为三种类型：（1）70%是被困在床垫和床栏之间，面部被压在床垫上；（2）18%是颈部被困在床栏内并受到挤压；（3）12%是部分滑下床后被床栏困住，颈部弯曲或胸部受压导致死亡。
床栏导致的死亡未得到充分认识，且是可预防的临床事件，可发生在任何医疗环境中。预防这些事件需要对床栏、床垫和床之间的关系进行统一重新设计，目前它们通常作为单独的产品进行组装和使用。临床医生可以通过更谨慎地使用床栏、确认床、床栏和床垫之间的正确关系以及使用警报器来预防许多此类死亡事件。
