Reactivation of nonemergent surgery during the mitigation phase of the SARS-CoV-2 pandemic has demanded prioritization of low-risk procedures, with potential shorter hospital lengths of stay and ICU occupation. However, pediatric surgical pathology warrants particular considerations, taking into account differences in clinical manifestations of SARS-CoV-2 infection in this population.1 , 2 We applied the pediatric Medically Necessary Time Sensitive (pMeNTS) prioritization process score for surgical cases in our pediatric surgery department between May and June 2020, with the purpose of identifying an institutional cut-off value for objectively selecting candidates suited for elective surgery.3 Outpatient and nonurgent inpatient cases were involved. A retrospective review of clinical records and extraction of parameters contemplated in the pMeNTS score was performed. The lower and higher cut-off values proposed in the original study (42 and 49 points, respectively) were taken into account for the results. Media and standard deviation were calculated for the analysis.
A total of 107 cases were included: 54 scheduled and 53 deferred. The average ages for each group were 8.7 years (SD 6.5 years) and 7.4 years (SD 4.2 years), respectively. The male-to-female ratios were 1.16:1 and 1.12:1 for each group. Deferrals of procedures were due to patient’s family reasons in 21 cases (39.6%), medical relevance in 16 cases (30.1%), mobility issues in 11 cases (20.8%), and concerns related to the pandemic in 5 cases (9.4%). In each group, the pMeNTS score was calculated, including 3 original categories: procedure-, disease-, and patient-related factors. For the group of scheduled patients, mean scores obtained for each category were 21 (SD 4.76), 16 (SD 3.98), and 8.9 (SD 1.98), respectively. Meanwhile, for the group of deferred cases, mean scores obtained for each category were 21 (SD 3.55), 21 (SD 3.07), and 9.2 (SD 2.61), respectively. The global mean score was 47 points (SD 6.52) for scheduled cases and 46 points (SD 5.46) for deferred cases. Finally, the global mean score for both groups was 47 (SD 6.02).
The pMeNTS score aims to guide decision-making in pediatric patients with surgical pathology during the SARS-CoV-2 pandemic. In our analysis, we identified a lower mean score for both scheduled and deferred patient groups compared with the cut-off values suggested in the original study. Therefore, we concluded that this tool does not encompass substantial utility in our setting, possibly due to the fact that reasons other than procedure, disease, and patient-related factors influenced deferral of surgery for most patients.
Footnotes
Disclosure Information: Nothing to disclose.
Information contained in this letter was presented virtually at the 22nd Colombian Congress of Pediatric Surgery, September 2020.
References
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