Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond

Autor: Timothy F. Witham, Nicholas Theodore, Edward C. Benzel, Sheng Fu L. Lo, Eric O. Klineberg, Dean Chou, Zach Pennington, Aladine A. Elsamadicy, Ali Bydon, Jeff Ehresman, Brian J. Neuman, Matthew L. Goodwin, C. Rory Goodwin, James S. Harrop, Daniel Lubelski, Themistocles S. Protopsaltis, Daniel M. Sciubba, Peter G. Passias, Ilya Laufer, James Feghali, John H. Shin, Benjamin D. Elder
Rok vydání: 2020
Předmět:
Medical ethics
Health care rationing
spine surgery
0302 clinical medicine
Pandemic
Health care
rationing
Viral
Resource allocation
CDC
Centers for Disease Control and Prevention
COVID-19
Coronavirus disease 2019
Health Care Rationing
ARDS
Acute Respiratory Distress Syndrome
ASIA
American Spinal Injury Association
medical ethics
Elective Surgical Procedures
030220 oncology & carcinogenesis
Rationing
Cohort
Medical emergency
Coronavirus Infections
Elective Surgical Procedure
AANS
American Association of Neurological Surgeons
Pneumonia
Viral
Decision Making
Clinical Sciences
Clinical Neurology
resource allocation
ADL
Activities of daily living
Article
CNS
Congress of Neurological Surgeons
Betacoronavirus
03 medical and health sciences
SNO
Society for Neuro-Oncology
Spine surgery
ACS
American College of Surgeons
ICU
Intensive Care Unit
medicine
Humans
CMS
Centers for Medicare and Medicaid Services
PPE
Personal protective equipment
Pandemics
SARS-CoV-2
business.industry
pandemic
Patient Selection
Neurosciences
COVID-19
Postoperative complication
Pneumonia
medicine.disease
Triage
Good Health and Well Being
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
Zdroj: World Neurosurgery
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2020.05.233
Popis: Background As of May 4, 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected >3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems worldwide, leading to the cancellation of elective surgical cases and discussions regarding health care resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak and may recur with future pandemics, creating a need for a means of triaging patients for emergent and elective spine surgery. Methods Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. Results The devised scoring system included 8 independent components: neurologic status, underlying spine stability, presentation of a high-risk postoperative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely available Web-based calculator ( https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/ ). Conclusions We present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, although not all encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.
Databáze: OpenAIRE
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