Reducing the Incidence of Cast-related Skin Complications in Children Treated With Cast Immobilization

DiFazio, Rachel; Harris, Marie; Feldman, Lanna; Mahan, Susan T.

doi:10.1097/bpo.0000000000000713

Cited by 27 publications

(46 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several other pediatric studies corroborate our findings. [3][4][5] It is worth mentioning, however, that most of the children with CstRP needed cast work to potentially prevent a compartment syndrome. In adults, neuropathic symptoms were reported in 6/296 (2%) of the patients with forearm fracture.…”

Section: Discussionmentioning

confidence: 99%

“…wet cast, loose cast), while others present with symptoms such as swelling, color change, skin irritation or pain around the distal part of the upper extremity (cast-related pain, CstRP). [3][4][5][6] Patients who have pain need to be urgently evaluated to rule out neurovascular deficit and are treated with analgesics, cast splitting, trimming, or replacement. 7 There is a paucity of literature on factors contributing to ED revisit due to CstRP in children with forearm fractures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures</p>

Kvatinsky

Carmiel

Leiba

et al. 2020

JPR

View full text Add to dashboard Cite

Background: Cast immobilization is the primary treatment for children with forearm fractures. After emergency department (ED) discharge, some patients develop cast-related pain (CstRP) around the distal part of the upper extremity. We examined variables associated with ED revisits due to CstRP in children with forearm fractures. Methods: A retrospective cohort study of all children who were treated with cast immobilization for forearm fracture over a 7-year period was conducted. Patient demographics, fracture location, casting method (below elbow/above elbow), first visit pain scores, treatment with fracture reduction, and revisit data were collected. Multivariate regression was used to identify predictors of revisits due to CstRP within 72 hrs post-discharge. Results: A total of 2307 children were treated with cast immobilization; 95 (4.2%) revisited the ED due to CstRP (median pain score 7, interquartile range 5-9). No patient had neurovascular compromise or required surgery or re-reduction. Fifty-eight (61.1%) patients were treated with cast splitting, 10 (10.5%) with trimming, and 27 (28.4%) with cast replacement. Variables on first visit that were associated with increased odds for ED revisit included treatment with fracture reduction (odds ratio [OR] 2.31; 95% confidence interval [CI] 1.58-3.36) and a median pain score of 6 or more upon ED presentation (OR 1.57; 95% CI 1.32-2.13). Discussion: A small number of children with forearm fractures revisited the ED due to CstRP. Study findings suggest that being treated with closed reduction and having a pain score ≥ 6 on the first visit were associated with ED revisit due to CstRP.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures</p>

Kvatinsky

Carmiel

Leiba

et al. 2020

JPR

View full text Add to dashboard Cite

show abstract

“…Skin complications from cast application is a common occurrence that can range from minor skin excoriations to severe pressure ulcers that can eventually require surgical debridement and coverage[ 31 ]. There are only several studies published that focused solely on pediatric skin complications associated with casting[ 12 , 31 ].…”

Section: Skin Complicationsmentioning

confidence: 99%

“…At these areas, more padding needs to be placed to prevent excessive pressure. Difazio et al[ 31 ] published a recent study on reducing the incidence of casted-related skin complications, more specifically heel pad ulcers. Through adding extra padding at the heel area in addition to respective provider education, they decreased the incidence of casted-related skin complications from 17.1 per 1000 lower extremity casts to 6.8.…”

Section: Skin Complicationsmentioning

confidence: 99%

Casting: Pearls and pitfalls learned while caring for children’s fractures

Nguyen¹,

McDowell²,

Schlechter³

2016

WJO

View full text Add to dashboard Cite

Casting is a routine procedure used for fracture care in the pediatric population. The purpose of this review is to provide pearls and pitfalls that our institution has learned from previous literature. When applying the cast, we recommend using cotton padding for the liner and fiberglass or plaster depending on how much swelling is expected. A well-molded cast must be applied in order to prevent further fracture displacement. Cast valving is a valuable technique that allows a decrease in pressure which prevents discomfort and complications like compartment syndrome. Preventing thermal injuries, skin complications, and a wet cast are other important considerations when caring for casts. Appropriate use of a cast saw, avoiding pressure spots, and properly covering the cast are ways to respectively prevent those complications. Lastly, patient education remains one of the most valuable tools in ensuring proper cast maintenance.

show abstract

“…Diferentes estudios han experimentado con múltiples métodos de prevención de úlceras por presión, tales como el relleno del talón con una cantidad extra de capas de algodón o diferentes tipos de almohadillado (13) e incluso diferentes formas de disponer la férula (14) . Otros autores, han tenido en cuenta los diferentes materiales, la presión que se ejerce y la temperatura que alcanza el yeso durante la ejecución (15) así como la colocación de una válvula de posición personalizada con descarga de presión en el talón (16) .…”

Section: Introductionunclassified

Prevención de úlceras iatrogénicas por inmovilización terapéutica en niños con férula. Ensayo clínico

Hernández

Vicente²,

Sánchez³

et al. 2020

Enf Global

View full text Add to dashboard Cite

Introducción: La inmovilización con férula de yeso en miembro inferior es un procedimiento frecuente para niños en los servicios de urgencias, el cual no está exento de riesgos relacionados con la inmovilidad y presión, sobre estos factores los enfermeros tienen que adoptar cuidados preventivos.Objetivo: Comprobar la eficacia del parche-talonera polimérico en la prevención de úlceras iatrogénicas en niños inmovilizados con férula de yeso en miembro inferior.Material y Método: Ensayo clínico aleatorio preventivo sobre pacientes pediátricos de 0 a 14 años que precisen inmovilización con férula de yeso en miembro inferior. Se realizó muestreo consecutivo no probabilístico simple ciego. Análisis estadístico descriptivo de las variables y test de la X2 con las variables aplicación del parche y aparición de úlceras.Resultados: Se obtuvo una muestra de n=74 pacientes. Se objetivó úlcera en 21.7% de pacientes, piel íntegra (48.2%) y eritema que palidece 30.1%. Se aplicó el test de la X2 para las variables aplicación de parche polimérico y aparición de úlcera, obteniendo X2=0.135 con p=0.713, y por tanto, no existe significación estadística entre estas dos variables.Conclusiones: No existe relación directa entre la prevención de úlceras por presión en niños inmovilizados con férula de yeso y la aplicación de parche protector polimérico. Es fundamental que los enfermeros/as ofrezcan una educación sanitaria de calidad en los cuidados y mantenimiento de la férula para evitar complicaciones. Introduction: Immobilization with plaster cast in lower limb is a frequent procedure for children in the emergency services, which is not without risks related to immobility and pressure, on these factors nurses have to adopt preventive care.Objective: To verify the efficacy of the polymeric heel patch in the prevention of iatrogenic ulcers in children immobilized with a plaster splint in the lower limb.Material and method: Preventive randomized clinical trial on pediatric patients aged 0 to 14 years who require immobilization with a lower limb cast cast. Simple blind non-probabilistic consecutive sampling was performed. Descriptive statistical analysis of the variables and X2 test with the application variables of the patch and the appearance of ulcers.Results: A total sample of n = 74 patients was obtained. Ulcer was observed in 21.7% of patients, whole skin (48.2%) and erythema that pales 30.1%. The X2 test was applied for the application of polymer patch and ulcer appearance variables, obtaining X2 = 0.135 with p = 0.713, and therefore, there is no statistical significance between these two variables.Conclusions: There is no direct relationship between the prevention of pressure ulcers in children immobilized with plaster splint and the application of polymeric protective patch. It is very important that nurses offer a quality health education in the care and maintenance of the splint to avoid complications.

show abstract

Reducing the Incidence of Cast-related Skin Complications in Children Treated With Cast Immobilization

Abstract: Level II.

Cited by 27 publications

References 6 publications

<p>Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures</p>

<p>Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures</p>

Casting: Pearls and pitfalls learned while caring for children’s fractures

Prevención de úlceras iatrogénicas por inmovilización terapéutica en niños con férula. Ensayo clínico

Contact Info

Product

Resources

About