Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us
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Datum
2021-02-27Autoren
Fernandez, NicolasPrada, Stefania
Avansino, Jeffrey
Chavarriaga, Julian
Hermida, Eduardo
Perez Niño, Jaime
Corporate Author(s)
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Cirugía y Especialidades. Urología
Pontificia Universidad Javeriana. Facultad de Medicina. Hospital Universitario San Ignacio
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Artículo de revista
ISSN
0179-0358 / 1437-9813 (Electrónico)
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Zusammenfassung
Introduction and objective: SARS-COV-2 pandemic has afected the population worldwide requiring social distancing,
quarantine and isolation as strategies to control virus propagation. Initial measures to reduce the burden to the health care
system during the pandemic included deferring elective surgery. These damage control measures did not take into account
the mid- and long-term implications. Management of congenital anomalies can be time sensitive with delays resulting
in permanent disability, morbidity and increased costs to the healthcare system. This study reports the results of using a
novel scoring system that enables triage of time sensitive congenital anomalies and pediatric surgical conditions and how
implementation of Enhanced Recovery After Surgery (ERAS®) principles allowed optimization of resources and reduced
the burden to the system while allowing for appropriate care of pediatric patients with urgent urologic surgical conditions.
Methods: We present a prospective case series of patients with congenital urological conditions scheduled and taken to surgery during COVID-19 pandemic. All pediatric urology cases that were pending and or scheduled for surgery at the moment
the pandemic struck as well as all cases that presented to the emergency department with urological conditions were triaged
and included for analysis using a modifed Medically Necessary, Time-Sensitive Procedures: Scoring System (MeNTS). A
modifed MeNTS was implemented for pediatric patients, giving more priority to the impact of deferring surgical intervention on patient’s prognosis. An individualized evaluation using this scoring system was applied to each patient. Intra- and
postoperative ERAS® principles were applied to all cases operated during the pandemic between March 20th and April 24th
to reduce the burden to the healthcare system.
Results A total of 49 patients were triaged and included for analysis with a mean age of 6.47 years of age. Adjusted MeNTS
showed that all clinically emergent cases had a score of 12 or less. Cases that could be postponed for 2 weeks but no longer
had a score between 13 and 15. The ones that could wait 6 weeks or longer had scores higher than 16. Score results were not
the same for similar procedures and individualized assessments resulted in scores based on an individual patient’s conditions.
From the total cases, implementation of ERAS® principles increased outpatient procedures from 68 to 90.4%.
Conclusion: Our results provide a novel triaging method to rank pediatric urological surgical management based on individualized patient’s clinical conditions. Cutof values of 12 and 16 allowed appropriate triage preventing the postponement of
urgent urologic cases during the COVID-19 pandemic. Implementation of ERAS® principles allowed for these procedures
to be done in the outpatient setting, preserving valuable healthcare resources.
Type of study: Prospective cohort study.
Level of evidence: IV.
Befristete Deckung
2020Gemeinschaft
Pacientes con condiciones urológicas congénitasVerknüpfen Sie mit der Ressource
https://link.springer.com/article/10.1007/s00383-021-04868-4Herkunft
Pediatric Surgery International; Volumen 37 Número 6 , Páginas 827 - 833 (2021)
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