Injury Prevention on the Road Home: A Hospital-Based Car Seat Loaner Program Evaluation

Kelly White, BS
Amy Watkins, MPH
Mark Lee, MD
Kevin Borrup, DrPH, JD, MPA
Jennifer Tabak, RN, MSN
Evan Fusaro, MSPAS, PA-C
Brendan Campbell, MD, MPH, FACS

Femur fractures are among the most common injuries requiring hospitalization in young children. Spica cast immobilization, a standard treatment for pediatric femur fractures, creates a significant challenge for safe vehicle transport at discharge. National guidelines recommend specialized car seats for these patients, yet many families face cost, availability, and care coordination barriers. Safe Kids Connecticut, a community program affiliated with a Level 1 pediatric trauma center, operates a Child Passenger Safety Program that loans adaptive car seats and provides caregiver education. This program evaluation examines the program’s reach, effectiveness, and sustainability.

From September 2021 through December 2024, data was collected on all patients under 6 years old who were treated at a Level 1 pediatric trauma center for femur fracture with spica cast stabilization. The Injury Prevention Center was notified when a patient needed a specialized car seat, and Child Passenger Safety Technicians (CPSTs) fit the child with an appropriate seat and instructed caregivers on proper use. Program reach is assessed by comparing operating room case data to CPST seat distribution records. Outcome measures include the number of seats distributed, completion of caregiver education, return rates, and average loan duration.

Thirty children received spica cast stabilization during the evaluation period. Of these, 80% (n=24) were discharged with a specialized car seat and received in-person education from a trained CPST. The program achieved an 86% return rate (n=26), with an average loan duration of 3.75 months (range: 2–6.5 months). One family kept their seat due to ongoing medical need, while three families have not returned their seats. The primary challenge to program sustainability is the high cost of medical-grade car seats, which range from $300 to over $2,000 and require periodic replacement due to expiration, damage, or loss.

A hospital-based loaner program that provides adaptive car seats and caregiver education addresses a critical gap in discharge safety for pediatric patients with spica casts. The program effectively reduces financial and logistical barriers for families, supports safer transitions home, and promotes injury prevention. Prompt communication between healthcare providers and CPSTs is important to ensure timely seat provision and prevent discharge delays. Sustained funding is essential to maintain seat inventory and ensure long-term program impact.

1. Describe the transportation safety needs of pediatric patients discharged in spica casts.

2. Identify key components of a sustainable hospital-based child passenger safety program.

3. Discuss challenges and strategies for overcoming financial and logistical barriers in car seat access.