Transportation of children in spica casts in the USA

Gockley, Allison; Hennrikus, William L.; Lavin, Shane T.; Rzucidlo, Susan; Rieghard, Cynthia

doi:10.1097/bpb.0000000000000169

Cited by 2 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Few studies have assessed the socioeconomic implications of orthopaedic immobilization. 11 For many families, the parent's ability to work outside the home is predicated on the child's ability to attend daycare. This is the first study to assess the potential for RTD after orthopaedic immobilization based on daycare facility policy.…”

Section: Discussionmentioning

confidence: 99%

“…Although complications of spica casting have previously been reported, missed workdays may be an understated social complication of spica casting. 8,10,11,23 reported low rates of RTD for children following single leg spica (22.5%), 1 and a half leg spica (18%), or 2 leg spica casts (16%). Caring for children in spica casts can require additional effort associated with toileting, mobility, and seating.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have assessed the socioeconomic implications of orthopaedic immobilization 11. For many families, the parent’s ability to work outside the home is predicated on the child’s ability to attend daycare.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] However, there are very few studies assessing the socioeconomical impact of casting on families. 11,12 In 2019, 91.3% of families with children had at least 1 parent employed and both parents were employed in 64.2% of married-couple families. 13 In single parent families, 85.2% of fathers parenting alone were employed and 75.4% of mothers parenting alone were employed.…”

mentioning

confidence: 99%

“…Previous literature has highlighted the medical complications associated with casting 8–10. However, there are very few studies assessing the socioeconomical impact of casting on families 11,12. In 2019, 91.3% of families with children had at least 1 parent employed and both parents were employed in 64.2% of married-couple families 13.…”

mentioning

confidence: 99%

See 4 more Smart Citations

The Impact of Cast Immobilization on Return to Daycare

Heffernan

Barnett

Nungesser

et al. 2021

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: Children who are prohibited from returning to daycare (RTD) after treatment with cast immobilization place an increased burden on parents and caregivers. The purpose of this study was to assess the impact of cast immobilization on RTD. Specifically, we sought to determine the prevalence of RTD after orthopaedic immobilization based on daycare facility policy. Methods: This was a survey study of randomly selected daycare facilities servicing a total of 6662 children within 10 miles of a major metropolitan city center. The 40-question survey included information on daycare policies and experience caring for children treated with orthopaedic immobilization. The survey also included questions about daycare type, enrollment, and geographic location. Photographs of the types of immobilization were embedded in the survey to facilitate understanding. Daycare facilities were randomly selected based on a power analysis to estimate a 50% prevalence of RTD after spica casting within 10% margin of error. Results: Seventy-three daycare facilities completed the survey study. The average child-staff ratio was 5:1 and most daycare facilities (78%) did not have a nurse on staff. Predetermined policies regarding RTD after injury were available at 81% of daycares. Twenty-eight (38.5%) facilities had encountered a child with a cast in the previous year. The rate of RTD for children with upper limb injuries was 90.5% compared with 79% for lower limb injuries (P = 0.003). Spica casts showed the lowest RTD rate: single leg (22.5%), 1 and a half leg (18%), and 2 leg (16%) (P < 0.0001). Experienced daycare facilities ( > 5 y) had a higher RTD rate compared with less experienced facilities (P = 0.026). Conclusions:The ability to RTD is dependent on immobilization type. Children with long leg and spica casts are disproportionately restricted when compared with other cast types. At minimum, surgeons should consider the socioeconomic implications of orthopaedic immobilization. There is also a need for orthopaedic involvement in policy formation at the local level to provide standardized guidelines for re-entry into childcare facilities following orthopaedic immobilization.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

The Impact of Cast Immobilization on Return to Daycare

Heffernan

Barnett

Nungesser

et al. 2021

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats

Adams

Johnson

Ryan

et al. 2019

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: Government regulations mandate appropriate vehicular restraints for children under 4 years of age. Patients treated for infantile developmental dysplasia of the hip (DDH) with spica casts often require special accommodations. Previous work suggests that car seat loaner programs may help achieve these goals while avoiding the need for costly ambulance transportation. The purpose of this study was to evaluate our center’s experience with postdischarge transportation in a large population of DDH infants and identify future threats to our program. Methods: We performed a retrospective review of patients 4 years or younger of age who underwent closed or open reduction for DDH at our center between 2011 and 2018. Only the initial surgery of staged procedures was included. Patient demographic factors were recorded, as were procedure type, final restraint used for postdischarge transportation, and any potential discharge delays secondary to transportation issues. Costs were compared amongst transportation options. Results: Our cohort consisted of 130 patients (mean age, 1.4±0.9 y; 98 females) treated for DDH. In total 41 children (31.5%) underwent closed reduction procedures, whereas 89 patients (68.5%) underwent open reductions. After reduction, 62 (47.7%) received 2-legged spica casts and 68 (52.3%) received 1.5-legged casts. The most common restraint was a hospital-loaned Hippo car seat (73, 55.8%) followed by family-owned car seats (27, 20.8%). Eight patients (6.2%) experienced delays in discharge while waiting for adequate restraints, 6 patients (4.6%) were transported by ambulance, and 4 patients (3.1%) left against medical advice with inadequate restraints. Conclusions: Following surgical treatment of DDH, over 50% of patients with a spica cast were discharged using our center’s car seat loaner program. However, availability and cost can present barriers for patients, with 4.6% of patients still being transported home by ambulance and 3.1% with inadequate restraints against medical advice. Costs of car seats are significant both for patients’ families intending to purchase them, as well as for hospitals maintaining loaner programs and replacing used/lost seats. Moving forward, the recent cessation of production of the most common “spica car seat” threatens the longevity of existing loaner programs and calls renewed attention to the issue of safe transportation in-spica from providers and car-seat manufacturers alike. Level of Evidence: Level III.

show abstract

Transportation of children in spica casts in the USA

Cited by 2 publications

References 13 publications

The Impact of Cast Immobilization on Return to Daycare

The Impact of Cast Immobilization on Return to Daycare

Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats

Contact Info

Product

Resources

About