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

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.

Alternative method to determine the hematocrit of red blood cell units: a potential use in the apheresis unit.

BACKGROUND: In automated erythrocytapheresis procedures, achieving the desired-end hematocrit (Hct) requires that the COBE Spectra (CaridianBCT) machine be programmed with the mean Hct of the replacement red blood cell (RBC) units. To determine unit Hct, data derived from quality control (QC) Hct data were utilized. However, if a unit volume is outside the quality control (QC) volume parameters, the unit is accessed to measure its Hct. In this study, 21 percent of all RBC units need to be accessed to determine the Hct, which affects 47.5 percent of patient's erythrocytapheresis procedures. Spiking the unit compromises its integrity and hastens the expiration time of the unit. Nurses must wait until the patient arrives to check units outside QC parameters, thereby delaying the start time of procedures. Even if sampled units are kept refrigerated, they cannot be returned to the blood bank inventory once spiked. The goal of this study was to determine if accurate Hct levels from RBC units could be obtained from a unique segment. STUDY DESIGN AND METHODS: To determine the centrifuged Hct, samples were prepared from the RBC units and compared to that of the unique segment. RESULTS: The Hct of the unique segment exceeded that of the RBC unit by a small (1.2% in AS-1 units, 0.92% in AS-3 units), but statistically significant amount. CONCLUSION: The Hct from unique RBC segments closely approximates that of the original RBC unit. Unique segments can be made that will maintain the integrity and shelf life of RBC units.