Table 3.
Patient-Specific Factors
| Variable | Category |
||||
|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | |
| Child's age | 12 y to 20 y | 5 y to younger than 12 y | 6 mo to younger than 5 y | Full term, or preterm infant ≥ 50 wk post conception age and younger than 6 mo |
Preterm infant < 50 wk post conception |
| Pediatric chronic lung disease, or cystic fibrosis, or pHTN | None | Mild BPD or asthma (no supplemental O2 required after 36 wk), or history of pHTN (resolved) | Intermittent bronchodilators, inhaled steroids, or mild to moderate pHTN (no current medications but needed for procedures) | Daily diuretics, bronchodilators, inhaled steroids, or moderate pHTN (single medication) | On supplemental O2 or history of respiratory hospitalizations or single lung or severe pHTN (multiple current medications) |
| OSA/difficult airway, AHI | No OSA or earlier intubation without airway concern | Mild OSA (AHI 1–5) | BMI < 15 kg/m2 Moderate OSA (AHI 6–10) |
BMI ≥ 25 kg/m2 Severe OSA (AHI 11–20) |
On CPAP or greater support, or ASA ≥ 3, or known difficult airway (AHI > 20) |
| Pediatric congenital heart disease | None | Minor (eg PFO or PDA) or repaired Moderate defect | Moderate (eg ASD, VSD) or repaired major defect | Major (eg transposition great vessels, pulmonic stenosis) or repaired severe defect | Severe (eg hypoplastic left heart, single ventricle) |
| Diabetes | None | — | Mild (no medications) | Moderate (po meds only) | More than moderate (insulin) |
| Immunocompromised∗ | No | — | Mild (pregnancy, single immunosuppressive medication) | Moderate (multiple immunosuppressive meds, chronic steroids) | Severe (malignancy, transplantation, recent chemotherapy) |
| ILI or COVID-19 symptoms (fever, cough, sore throat, body aches, diarrhea, etc) | None (asymptomatic) | — | — | — | Yes |
| Exposure to known COVID-positive patient (past 14 d) | No | Probably not | Possibly | Probably | Yes |
Patient score 8 to 40. Total combined score = procedure + disease + patient. Higher score is associated with potentially worse outcomes, increased risk to providers, and/or increased hospital resource use.
AHI, apnea hypopnea index; ASA, American Society of Anesthesiologists; ASD, atrial septal defect; BPD, bronchopulmonary dysplasia; ILI, influenza-like illness; OSA, obstructive sleep apnea; PDA, patent ductus arteriosus; PFO, patent foramen ovale; pHTN, pulmonary hypertension; VSD, ventricular septal defect.
Hematologic malignancy, stem cell transplantation, solid organ transplantation, active cytotoxic chemotherapy, anti-tumor necrosis factor-α, immunosuppressants, steroid use, congenital immunodeficiency, hypogammaglobulinemia on IV immunoglobulin, HIV with CD4 < 200 cells/mm3.