Keshet Doron, Bernstein Mitchell, Dahan-Oliel Noemi, Ouellet Jean, Pauyo Thierry, Rabau Oded, Saran Neil, Hamdy Reggie
Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada.
Montreal Children's Hospital, Montreal, Quebec, Canada.
J Child Orthop. 2020 Jun 1;14(3):161-166. doi: 10.1302/1863-2548.14.200107.
To explore safe delays for the treatment of common paediatric orthopaedic conditions when faced with a life-threatening pandemic, COVID-19, and to propose a categorization system to address this question.
Review of the literature related to acceptable delays for treatment of common orthopaedic conditions, experience of healthcare professionals from low resource communities and expertise of experienced surgeons.
Guidelines for the management of cancellations of elective surgeries during a period of resource reallocation are proposed. Elective cases must not be postponed indefinitely as adverse outcomes may result. Triage of waiting lists should include continuous monitoring of the patient and close communication with families despite social distancing and travel restrictions. Telehealth becomes a necessity. Common orthopaedic conditions are triaged into four groups according to urgency and safe and acceptable delay. Categories proposed are Emergent (life and limb threatening conditions), Urgent (within seven days), Semi-elective (postponed for three months) and Elective (postponed for three to 12 months). In total, 25 common orthopaedic conditions are reviewed and categorized.
Given the uncertainty within healthcare during a pandemic, it is necessary to determine acceptable delays for elective conditions. We report our experience in developing guidelines and propose categorizing elective cases into four categories, based on the length of delay. Telemedicine plays a key role in determining the gravity of each situation and hence the amount of delay. These guidelines will assist others dealing with elective cases in the midst of a crisis. This paper initiates a coordinated effort to develop a consensus statement on safe delays.Published without peer review.
探讨在面对危及生命的大流行疾病新冠病毒肺炎（COVID-19）时，常见小儿骨科疾病治疗的安全延迟时间，并提出一个分类系统来解决这一问题。
回顾与常见骨科疾病治疗可接受延迟时间相关的文献、低资源社区医疗专业人员的经验以及经验丰富外科医生的专业知识。
提出了在资源重新分配期间择期手术取消管理的指南。择期病例不得无限期推迟，因为可能会产生不良后果。尽管有社交距离和旅行限制，但等待名单的分诊应包括对患者的持续监测以及与家属的密切沟通。远程医疗成为必需。常见骨科疾病根据紧迫性以及安全和可接受的延迟时间分为四组。提出的类别为紧急（危及生命和肢体的情况）、 urgent（七天内）、半择期（推迟三个月）和择期（推迟三至十二个月）。总共对25种常见骨科疾病进行了审查和分类。
鉴于大流行期间医疗保健的不确定性，有必要确定择期情况的可接受延迟时间。我们报告了我们制定指南的经验，并建议根据延迟时间长度将择期病例分为四类。远程医疗在确定每种情况的严重性以及因此确定延迟量方面起着关键作用。这些指南将帮助其他人在危机中处理择期病例。本文发起了一项协调努力，以就安全延迟制定一份共识声明。未经同行评审发表。
