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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.

Publication ,  Journal Article
Sciubba, DM; Ehresman, J; Pennington, Z; Lubelski, D; Feghali, J; Bydon, A; Chou, D; Elder, BD; Elsamadicy, AA; Goodwin, CR; Goodwin, ML ...
Published in: World Neurosurg
August 2020

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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Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

August 2020

Volume

140

Start / End Page

e373 / e380

Location

United States

Related Subject Headings

  • Triage
  • SARS-CoV-2
  • Pneumonia, Viral
  • Patient Selection
  • Pandemics
  • Humans
  • Health Care Rationing
  • Elective Surgical Procedures
  • Decision Making
  • Coronavirus Infections
 

Citation

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Sciubba, D. M., Ehresman, J., Pennington, Z., Lubelski, D., Feghali, J., Bydon, A., … Benzel, E. C. (2020). 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. World Neurosurg, 140, e373–e380. https://doi.org/10.1016/j.wneu.2020.05.233
Sciubba, Daniel M., Jeff Ehresman, Zach Pennington, Daniel Lubelski, James Feghali, Ali Bydon, Dean Chou, et al. “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.World Neurosurg 140 (August 2020): e373–80. https://doi.org/10.1016/j.wneu.2020.05.233.
Sciubba DM, Ehresman J, Pennington Z, Lubelski D, Feghali J, Bydon A, et al. 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. World Neurosurg. 2020 Aug;140:e373–80.
Sciubba, Daniel M., et al. “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.World Neurosurg, vol. 140, Aug. 2020, pp. e373–80. Pubmed, doi:10.1016/j.wneu.2020.05.233.
Sciubba DM, Ehresman J, Pennington Z, Lubelski D, Feghali J, Bydon A, Chou D, Elder BD, Elsamadicy AA, Goodwin CR, Goodwin ML, Harrop J, Klineberg EO, Laufer I, Lo S-FL, Neuman BJ, Passias PG, Protopsaltis T, Shin JH, Theodore N, Witham TF, Benzel EC. 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. World Neurosurg. 2020 Aug;140:e373–e380.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

August 2020

Volume

140

Start / End Page

e373 / e380

Location

United States

Related Subject Headings

  • Triage
  • SARS-CoV-2
  • Pneumonia, Viral
  • Patient Selection
  • Pandemics
  • Humans
  • Health Care Rationing
  • Elective Surgical Procedures
  • Decision Making
  • Coronavirus Infections