Contact Lens Injury Leading Cause Of Medical Device Emergency

A government report says that contact lens injury is the leading cause of over 70,000 emergency department (ED) visits every year for medical device-associated injury among US children and that more public health initiatives are needed to prevent such easily averted injuries in children, which are often due to wearing lenses for too long and not cleaning them properly.

The report, by researchers from the US Food and Drug Administration (FDA), is the first ever comprehensive study of medical device-associated injuries among US children and appears in the 26 July issue of the journal Pediatrics.

The authors write that injury is currently the primary cause of death for children in the US, being responsible for around 16,000 deaths every year, with more than two thirds of them attributable to unintentional injuries.

Their study estimated that nearly 145,000 medical device associated injuries among children aged 0 to 21 years were seen in emergency departments throughout the US during 2003 and 2004, involving 13 medical specialties.

This figure represents less than 1 per cent of the 20 million or so visits to emergency departments (ED) due to unintentional injury in this population over the same 24 month period.

The report highlights include:

The most prevalent types of medical device associated injuries seen in EDs in 2003 and 2004 included contusions or abrasions, foreign-body intrusions, punctures, lacerations, and infections.

The most frequently affected parts of the body were the eyeball, pubic region, finger, face, and ear.

Most of the children treated were adolescents aged 16 to 21 years, accounting for nearly half of the national estimate, followed by 11 to 15 year olds, accounting for 1 in 5 visits.

The risk of attending ED due to medical device associated injury among adolescents 16 to 21 years of age was twice the risk among 11 to 15 year olds and three times the risk among 3 to 10 year olds.

This pattern reflects the overall pattern of unintentional injury among US children.

More girls than boys were affected in the adolescent age group (16 to 21 years) and more boys than girls in the 10 years and under group.

Nearly a third of the total medical device associated injuries among children involved ophthalmic devices, and more than one fifth (23 per cent) involved contact lenses, with children aged 11 years and over being the most affected group, in line with prescription trends.

The most frequently reported injury related to contact lenses were: corneal contusions and abrasions, conjunctivitis, and hemorrhage: they were mostly superficial and did not require hospitalization.

Common reasons given for contact lens injury related to not following given instructions for when and how long to wear them, and not following recommendations for correct cleaning, wearing, and care.

After ophthalmic devices, hypodermic needles were the next most commonly cited device, accounting for 8 per cent of the overall estimate for medical device associated injuries among children.

The injury pattern in each age group tends to reflect the main developmental changes and disease risks of that group.

For example, contact lens injury accounted for over 40 per cent of medical deviced associated injury in adolescents aged 16 to 21, and 16 per cent of injuries in this age group involved obstetric/gynecologic devices.

In contrast, the largest proportion of medical device associated injuries due to cardiovascular devices, was among children under 5, and the most common medical device associated injury among the under 5s was related to tympanostomy tube (ear grommet).
The authors concluded that the study “highlights the need to develop interventions to prevent pediatric device-related injuries”.

In relation to contact lens wear, they recommend that practitioners give full detailed instruction on the routines for cleaning, wearing and caring for contact lenses and review this carefully at follow up evaluations.

They also recommend that parents be involved in the entire process of lens fitting, care and follow up monitoring.

The report found that the most serious problems were infections and overdoses related to implanted devices such as brain shunts for children with hydrocephalus (water on the brain), insulin pumps for diabetics and chest catheters for children receiving chemotherapy at home.

However, of those affected by these injuries, only 6 per cent overall had to stay in hospital.

Dr. Steven Krug, head of emergency medicine at Chicago’s Children’s Memorial Hospital, told the Associated Press that home care be challenging for families. Children have come to his emergency department because their catheter was damaged or became infected.

Krug, who was not involved in the study, said that health professionals need to be aware of children that have these devices and how to recognize or diagnose the problems they can cause.

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