The Washington Post had an AP scare headline: Medical device problems hurt 70,000+ kids annually.

Oh Heavens, another headline for doctor haters to point fingers at hard working docs.

So ignore the headline, and let’s go to the Journal Pediatrics to see what the real story is.

First of all, the definition of “medical devices” is quite broad.

If you ever scratched your eye putting on your glasses or eye protectors, you’re on their list.  If your 8 year old got Grandmom’s wheelchair or scooter and raced it down the corridor of her apartment building, and crashed, that’s there too.  If you fell and cut your cheek with your toothbrush, had a retainer scratch your gum, or had a filling fall out and you rushed to the Emergency room, you are on the list. If your stitches broke before the doc removed them, or if they got infected and you went to the Emergency room, that’s there too. If a needle broke off during injection, it’s there too,  lumping together those that broke because of manufacturing errors (the syringe was poorly made), poor technique (the kid jumped), or other reasons (it was being used for the fifteenth time by an addict) are related. Presumably cases like the  five kids I treated after a mischievous kid grabbed a diabetic kid’s syringe and went around sticking other kids in his school for fun would be on that list too.

Then there is the definition of “kids” (or what the Pediatrics article calls “children”).  It includes everyone up to the age of 21, (which is why the list includes pregnancy risk from a broken condom).

Another reason that minor injuries might be included: If you hurt yourself in a hospital or medical office, often the doc sends you to the ER to get “checked” so he has it on paper you weren’t injured, in case of a lawsuit.

So if we throw out a lot of this nonsense, what do we learn?

First: Contact lens associated injuries and infections are the most common problem: 33,000 cases a year. This suggests that we might not want to give our 14 year old contact lenses, or we might want to do more education or supervision so that they clean them, insert them, and wear them correctly.

Second: Injuries from casts, associated with crutches, or due to ice packs suggest we need better ways to treat fractures. Luckily, orthopedic devices have improved in the last 40 years, but again we need training to parents on cast care. Maybe a better design for crutches could help too.

Third, the Gynecological data is unclear, but avoiding tampons in very young teens might help stop the injury/retention problem, and the inclusion of (thank goodness rare) injury during gynecological examination suggests that some medical personnel might need more sensitivity training.

Fourth: cuts from toothbrushes suggests maybe softer shafts for kid’s toothbrushes might help, as might the newer “soft” retainers.

Fifth: Ear injuries from putting in ear-drops suggest that not everyone is using the newer safer bottles that prevent deep insertion. (Q-tip or cotton swab injuries are not listed, but I recently spotted a “flanged” swab to prevent ear cleaning injuries here in the Philippines). Another problem seems to be ear infections when a child has “ear tubes”, but the study doesn’t mention the source of infection. ( some of these infections come from “below”, e.g. with a cold, and some come from “outside”, e.g. getting water in the ear because Johnny forgot to put his earplugs in during swim practice. )

Most of the above are ordinary problems when you get hyperactive or careless kids using anything. (For example, how many kids end up in the Emergency room with Pencil related injuries?)

The real problem is with what we docs would actually call “medical devices”: Syringes and insulin pumps in diabetic kids, Shunts for Hydrocephalus, and IV ports to give cancer chemotherapy or long term antibiotics.

Some of these problems have been around for years, and are a problem of imperfect devices in growing kids (e.g. hydrocephalus devices, heart valves). The specialist journals have ongoing debates about these problems, so these problems are being addressed.

However, the problem with IV ports and shunts is a “new” problem, because until the last decade, a lot of this IV therapy was given by doctors or trained nurses in medical facilities (offices, ER’s or outpatient areas of the hospital). Now we often expect parents to keep it clean, and give the medicine. And the newer devices that allow repeated injections, such as the catheter in the shoulder that goes into a large vein, can be complicated, and can vary from one device to the next.

A similar problem can be found with infected Dialysis stents or catheters, broken stitches, many infections of sutures/wounds, or even irritation at colostomy sites.

Allowing payment reimbursement for teaching visits would help, as would home visits by those trained in their care. When I worked with the IHS, tribal health workers were trained to periodically visit our patients to check and dress wounds. Trained nurses went to the home of those who were getting long term antibiotic therapy, even when the family was doing most of the care. Every such visit was a “teaching” exercise, and often other medical problems were detected during the visit.

Ironically, I’m old enough to remember when folks were hospitalized for months to get such care. Home care is better, but often bureaucratic regulations don’t see the difference between a child staying with his nurse-mom in a suburb or a child 40 miles away from the nearest hospital staying with his elderly non-English-speaking grandmother, along with four other siblings in a two bedroom rural home.

In summary, by including apples with oranges, we have a new “statistic” for the paranoid to throw at physicians.

A better study would be to concentrate on one variation of injury, and suggest solutions for that injury.

Some of the “injuries” are unavoidable, some can be decreased with newer devices if they were more widely available and paid for (e.g. Softer, adjustable splint instead of fiberglass casts).

Other problems (e.g. broken or infected stitches, broken casts) are inevitable in active kids who may not follow directions.

But if we look closely, we might decide that the place to start is:

1) insisting on hygiene at every level of care is needed (and this means you, doc!)

2) Even if it is more expensive for a trained nurse or nursing assistant to make home visits to care for wounds or to give chemotherapy, some of these infections and injuries could be prevented.(and this means you, insurance companies!).

3) Avoid contact lenses in immature teenagers.

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Nancy Reyes is a retired physician living in the rural Philippines. She blogs at Finest Kind Clinic and Fishmarket and writes about medicine at HeyDoc XangaBlog.

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