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When it comes to medical equipment, one size doesn’t fit all

“We have a critically ill 2-year-old window fall victim. Initial scans show a displaced temporal bone fracture and internal bleeding. We’d like to transfer them to your trauma department for further care.”
Teddy bear on bed
A room in the emergency department for OHSU Doernbecher Children's Hospital. (OHSU/Kristyna Wentz-Graff)

OHSU Doernbecher’s emergency department frequently receives these calls from community hospitals. And, as a level 1 pediatric trauma center able to provide the highest-quality specialty care, Doernbecher regularly accepts such request for transfer.

Pediatric medicine is unique. While its patients may be perceived as small versions of adults, they are not. A child requires a specialized standard of care that considers not only varying body proportions, but emotional and developmental differences as well.

A lack of support for pediatric medical device development has created a global barrier to this gold standard of care.

In the case of a pediatric head trauma, such as a window fall, it is routine to place a child in a cervical collar prior to an ambulance ride to the hospital. This helps stabilize the child’s neck. Minimizing the impact of existing, or additional, injury. Unfortunately, because access to pediatric-sized collars is limited, a large percentage of patients arrive at the emergency department wearing ill-fitted adult-sized collars, or – in some cases -- have had a sheet taped around their head to hold it still.

Similarly, while a standard device – such as a blood pressure monitor – may be simple for an adult to endure, the loud noises and squeezing arm cuff can be frightening to a young child. This can make the necessary act of collecting accurate vital signs nearly impossible, and traumatic for all involved.

For these reasons, it is essential that medical equipment be focused on the unique attributes of children, based on their age and size. Without specific pediatric technology, the results of diagnostic tests of outcomes from equipment can be inaccurate and potentially dangerous.

outside ER building
OHSU Doernbecher Children’s Hospital is the first hospital in the Pacific Northwest to earn dual verifications for Level 1 Pediatric Trauma Center and a Level 1 Site for Children’s Surgery, according to the American College of Surgeons. (OHSU)

As a first step, the Federal Drug Administration in conjunction with the American Academy of Pediatrics has developed the Pediatric Device Consortia Grants Program which expands funding opportunities for the development, production and distribution of pediatric medical devices. Earlier this year, OHSU and nine other members of a network known as the West Coast Consortium for Technology and Innovation in Pediatrics, received more than $6 million from the PDCGP to support new medical device innovation and small businesses focused on pediatric medical technology development. Resulting devices could yield new cutting-edge treatment opportunities that span pediatric home health, acute and critical care.

While this opens the door for dozens of West Coast clinician-scientists to expand the footprint of pediatric medical technology, more funding and support is necessary to ensure that every child across the world has access to the proper medical equipment necessary to ensure accurate diagnosis, measure proper dosage, and deliver the best care possible.

Sheets should be used on our beds, not for stabilizing the necks of our most vulnerable patient population.

David Sheridan, M.D., M.C.R., is an assistant professor of pediatrics (emergency medicine) at OHSU Doernbecher Children’s Hospital, and is the co-director for Emergency Clinical Innovation at OHSU.

The West Coast Consortium for Technology and Innovation in Pediatrics is supported by the U.S. Food and Drug Administration’s Office of Orphan Product Development (grant number 1P50FD006425-01) awarded to UCLA Health.

CTIP network members include UCLA, OHSU, University of Southern California, Children’s Hospital Los Angeles, University of California San Diego, University of California Berkeley, Seattle Children’s Hospital, Cedars-Sinai Accelerator, LA BioMed, and Project Zygote.


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