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Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us

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dc.contributor.authorFernandez, Nicolas
dc.contributor.authorPrada, Stefania
dc.contributor.authorAvansino, Jeffrey
dc.contributor.authorChavarriaga, Julian
dc.contributor.authorHermida, Eduardo
dc.contributor.authorPerez Niño, Jaime
dc.contributor.corporatenamePontificia Universidad Javeriana. Facultad de Medicina. Departamento de Cirugía y Especialidades. Urologíaspa
dc.contributor.corporatenamePontificia Universidad Javeriana. Facultad de Medicina. Hospital Universitario San Ignaciospa
dc.contributor.javerianateacherPerez Niño, Jaime
dc.coverage.temporal2020
dc.date.accessioned2022-05-31T17:11:29Z
dc.date.available2022-05-31T17:11:29Z
dc.date.created2021-02-27
dc.description.abstractIntroduction 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.spa
dc.description.comunidadPacientes con condiciones urológicas congénitas
dc.description.esciNospa
dc.description.indexingRevista Internacional - Indexadaspa
dc.description.orcidhttps://orcid.org/0000-0002-9675-5963
dc.description.orcidhttps://orcid.org/0000-0003-4297-6215
dc.description.orcidhttps://orcid.org/0000-0003-0363-5485
dc.description.orcidhttps://orcid.org/0000-0002-2231-4321
dc.description.publindexA2spa
dc.description.quartilescopusQ2spa
dc.description.quartilewosQ3
dc.formatPDFspa
dc.format.mimetypeapplication/pdfspa
dc.identifierhttps://link.springer.com/article/10.1007/s00383-021-04868-4spa
dc.identifier.doihttps://doi.org/10.1007/s00383-021-04868-4spa
dc.identifier.instnameinstname:Pontificia Universidad Javerianaspa
dc.identifier.issn0179-0358 / 1437-9813 (Electrónico)spa
dc.identifier.reponamereponame:Repositorio Institucional - Pontificia Universidad Javerianaspa
dc.identifier.repourlrepourl:https://repository.javeriana.edu.cospa
dc.identifier.urihttp://hdl.handle.net/10554/60035
dc.relation.citationendpage833spa
dc.relation.citationissue6spa
dc.relation.citationstartpage827spa
dc.relation.citationvolume37spa
dc.relation.ispartofjournalPediatric Surgery Internationalspa
dc.rights.coarhttp://purl.org/coar/access_right/c_abf2spa
dc.rights.licenceAtribución-NoComercial 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/*
dc.subjectEnhanced recovery after surgeryspa
dc.subjectPediatricsspa
dc.subjectCOVID-19 pandemicspa
dc.subjectSARS-COV-2 pandemicspa
dc.titleRisk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us
dc.type.coarhttp://purl.org/coar/resource_type/c_6501spa
dc.type.hasversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.localArtículo de revistaspa

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