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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.
Sciubba, Daniel M; Ehresman, Jeff; Pennington, Zach; Lubelski, Daniel; Feghali, James; Bydon, Ali; Chou, Dean; Elder, Benjamin D; Elsamadicy, Aladine A; Goodwin, C Rory; Goodwin, Matthew L; Harrop, James; Klineberg, Eric O; Laufer, Ilya; Lo, Sheng-Fu L; Neuman, Brian J; Passias, Peter G; Protopsaltis, Themistocles; Shin, John H; Theodore, Nicholas; Witham, Timothy F; Benzel, Edward C.
  • Sciubba DM; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: dsciubb1@jhmi.edu.
  • Ehresman J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Pennington Z; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Lubelski D; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Feghali J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Bydon A; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Chou D; Department of Neurological Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA.
  • Elder BD; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
  • Elsamadicy AA; Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
  • Goodwin CR; Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.
  • Goodwin ML; Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Harrop J; Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Philadelphia, USA.
  • Klineberg EO; Department of Orthopedic Surgery, University of California Davis School of Medicine, Davis, California, USA.
  • Laufer I; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Lo SL; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Neuman BJ; Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Passias PG; Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University LangoneHealth, New York, New York, USA.
  • Protopsaltis T; Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University LangoneHealth, New York, New York, USA.
  • Shin JH; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Theodore N; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Witham TF; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Benzel EC; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA.
World Neurosurg ; 140: e373-e380, 2020 08.
Article in English | MEDLINE | ID: covidwho-593961
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Health Care Rationing / Elective Surgical Procedures / Coronavirus Infections / Patient Selection / Pandemics / Betacoronavirus Type of study: Cohort study / Observational study / Prognostic study / Qualitative research Topics: Long Covid Limits: Humans Language: English Journal: World Neurosurg Journal subject: Neurosurgery Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Health Care Rationing / Elective Surgical Procedures / Coronavirus Infections / Patient Selection / Pandemics / Betacoronavirus Type of study: Cohort study / Observational study / Prognostic study / Qualitative research Topics: Long Covid Limits: Humans Language: English Journal: World Neurosurg Journal subject: Neurosurgery Year: 2020 Document Type: Article