Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us
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 surge...
- Autores:
-
Fernandez, Nicolas
Prada, Stefania
Avansino, Jeffrey
Chavarriaga, Julian
Hermida, Eduardo
Perez Niño, Jaime
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2021
- Institución:
- Pontificia Universidad Javeriana
- Repositorio:
- Repositorio Universidad Javeriana
- Idioma:
- OAI Identifier:
- oai:repository.javeriana.edu.co:10554/60035
- Acceso en línea:
- https://link.springer.com/article/10.1007/s00383-021-04868-4
http://hdl.handle.net/10554/60035
https://doi.org/10.1007/s00383-021-04868-4
- Palabra clave:
- Enhanced recovery after surgery
Pediatrics
COVID-19 pandemic
SARS-COV-2 pandemic
- Rights
- License
- Atribución-NoComercial 4.0 Internacional
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dc.title.none.fl_str_mv |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us |
title |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us |
spellingShingle |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us Enhanced recovery after surgery Pediatrics COVID-19 pandemic SARS-COV-2 pandemic |
title_short |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us |
title_full |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us |
title_fullStr |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us |
title_full_unstemmed |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us |
title_sort |
Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us |
dc.creator.fl_str_mv |
Fernandez, Nicolas Prada, Stefania Avansino, Jeffrey Chavarriaga, Julian Hermida, Eduardo Perez Niño, Jaime |
dc.contributor.author.none.fl_str_mv |
Fernandez, Nicolas Prada, Stefania Avansino, Jeffrey Chavarriaga, Julian Hermida, Eduardo Perez Niño, Jaime |
dc.contributor.corporatename.spa.fl_str_mv |
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Cirugía y Especialidades. Urología Pontificia Universidad Javeriana. Facultad de Medicina. Hospital Universitario San Ignacio |
dc.contributor.javerianateacher.none.fl_str_mv |
Perez Niño, Jaime |
dc.subject.spa.fl_str_mv |
Enhanced recovery after surgery Pediatrics COVID-19 pandemic SARS-COV-2 pandemic |
topic |
Enhanced recovery after surgery Pediatrics COVID-19 pandemic SARS-COV-2 pandemic |
description |
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. |
publishDate |
2021 |
dc.date.created.none.fl_str_mv |
2021-02-27 |
dc.date.accessioned.none.fl_str_mv |
2022-05-31T17:11:29Z |
dc.date.available.none.fl_str_mv |
2022-05-31T17:11:29Z |
dc.type.local.spa.fl_str_mv |
Artículo de revista |
dc.type.coar.spa.fl_str_mv |
http://purl.org/coar/resource_type/c_6501 |
format |
http://purl.org/coar/resource_type/c_6501 |
dc.identifier.spa.fl_str_mv |
https://link.springer.com/article/10.1007/s00383-021-04868-4 |
dc.identifier.issn.spa.fl_str_mv |
0179-0358 / 1437-9813 (Electrónico) |
dc.identifier.uri.none.fl_str_mv |
http://hdl.handle.net/10554/60035 |
dc.identifier.doi.spa.fl_str_mv |
https://doi.org/10.1007/s00383-021-04868-4 |
dc.identifier.instname.spa.fl_str_mv |
instname:Pontificia Universidad Javeriana |
dc.identifier.reponame.spa.fl_str_mv |
reponame:Repositorio Institucional - Pontificia Universidad Javeriana |
dc.identifier.repourl.spa.fl_str_mv |
repourl:https://repository.javeriana.edu.co |
url |
https://link.springer.com/article/10.1007/s00383-021-04868-4 http://hdl.handle.net/10554/60035 https://doi.org/10.1007/s00383-021-04868-4 |
identifier_str_mv |
0179-0358 / 1437-9813 (Electrónico) instname:Pontificia Universidad Javeriana reponame:Repositorio Institucional - Pontificia Universidad Javeriana repourl:https://repository.javeriana.edu.co |
dc.relation.citationstartpage.spa.fl_str_mv |
827 |
dc.relation.citationendpage.spa.fl_str_mv |
833 |
dc.relation.ispartofjournal.spa.fl_str_mv |
Pediatric Surgery International |
dc.relation.citationvolume.spa.fl_str_mv |
37 |
dc.relation.citationissue.spa.fl_str_mv |
6 |
dc.rights.licence.*.fl_str_mv |
Atribución-NoComercial 4.0 Internacional |
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http://creativecommons.org/licenses/by-nc/4.0/ |
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http://purl.org/coar/access_right/c_abf2 |
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Atribución-NoComercial 4.0 Internacional http://creativecommons.org/licenses/by-nc/4.0/ http://purl.org/coar/access_right/c_abf2 |
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2020 |
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Pontificia Universidad Javeriana |
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http://repository.javeriana.edu.co/bitstream/10554/60035/1/a3546.pdf http://repository.javeriana.edu.co/bitstream/10554/60035/2/a3546.pdf.jpg |
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Atribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/http://purl.org/coar/access_right/c_abf2Fernandez, NicolasPrada, StefaniaAvansino, JeffreyChavarriaga, JulianHermida, EduardoPerez Niño, JaimePontificia Universidad Javeriana. Facultad de Medicina. Departamento de Cirugía y Especialidades. UrologíaPontificia Universidad Javeriana. Facultad de Medicina. Hospital Universitario San IgnacioPerez Niño, Jaime20202022-05-31T17:11:29Z2022-05-31T17:11:29Z2021-02-27https://link.springer.com/article/10.1007/s00383-021-04868-40179-0358 / 1437-9813 (Electrónico)http://hdl.handle.net/10554/60035https://doi.org/10.1007/s00383-021-04868-4instname:Pontificia Universidad Javerianareponame:Repositorio Institucional - Pontificia Universidad Javerianarepourl:https://repository.javeriana.edu.coIntroduction 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.Q3Q2Pacientes con condiciones urológicas congénitashttps://orcid.org/0000-0002-9675-5963https://orcid.org/0000-0003-4297-6215https://orcid.org/0000-0003-0363-5485https://orcid.org/0000-0002-2231-4321Revista Internacional - IndexadaA2NoPDFapplication/pdfEnhanced recovery after surgeryPediatricsCOVID-19 pandemicSARS-COV-2 pandemicRisk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught usArtículo de revistahttp://purl.org/coar/resource_type/c_6501827833Pediatric Surgery International376ORIGINALa3546.pdfapplication/pdf637414http://repository.javeriana.edu.co/bitstream/10554/60035/1/a3546.pdfb45993661e53b14eab45e350a300abd9MD51open accessTHUMBNAILa3546.pdf.jpga3546.pdf.jpgIM Thumbnailimage/jpeg9501http://repository.javeriana.edu.co/bitstream/10554/60035/2/a3546.pdf.jpg731119fef33fc34cc6e19a4828b51bcbMD52open access10554/60035oai:repository.javeriana.edu.co:10554/600352023-04-26 12:45:37.396Repositorio Institucional - Pontificia Universidad Javerianarepositorio@javeriana.edu.co |