Blumberg Todd J, Adler Adam C, Lin Elaina E, Fazal Faris Z, Talwar Divya, Ellingsen Kyle, Chandrakantan Arvind, Chen Jingyang, Shah Apurva S
Department of Orthopedics and Sports Medicine, Seattle Children's Hospital.
Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX.
J Pediatr Orthop. 2020 Nov/Dec;40(10):e990-e993. doi: 10.1097/BPO.0000000000001657.
The COVID-19 pandemic has substantially altered the typical process around performing surgery to ensure protection of health care workers, patients, and their families. One safety precaution has been the implementation of universal preoperative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examines the results of universal screening on children undergoing orthopaedic surgery.
This is a retrospective cohort study evaluating the incidence and symptomatology of COVID-19 in all patients presenting for orthopaedic surgery at 3 pediatric tertiary care children's hospitals during the COVID-19 pandemic (March to June 2020). All patients underwent universal screening with a nasopharyngeal swab to detect presence of SARS-CoV-2. Bivariate and multivariate logistic regression analysis was performed to identify risk factors for positive COVID-19 screening.
In total, 1198 patients underwent preoperative screening across all 3 institutions and 7 (0.58%) had detection of SARS-CoV-2. The majority of patients (1/7, 86%) were asymptomatic. Patients that tested positive were significantly more likely to be Hispanic (P=0.046) and had greater number of medical comorbidities (P=0.013), as scored on the American Society of Anesthesiologists (ASA) physical status score. A known COVID-19 positive contact was found to be a significant risk factor in the multivariate analysis (P=0.004).
Early results of universal preoperative screening for COVID-19 demonstrates a low incidence and high rate of asymptomatic patients. Health care professionals, especially those at higher risk for the virus, should be aware of the challenges related to screening based solely on symptoms or travel history and consider universal screening for patients undergoing elective surgery.
Level II.
新型冠状病毒肺炎（COVID-19）大流行极大地改变了进行手术的常规流程，以确保医护人员、患者及其家属的健康安全。一项安全预防措施是对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）进行术前普遍筛查。本研究调查了对接受骨科手术儿童进行普遍筛查的结果。
这是一项回顾性队列研究，评估在COVID-19大流行期间（2020年3月至6月），3家儿科三级护理儿童医院中所有接受骨科手术患者的COVID-19发病率和症状。所有患者均接受鼻咽拭子普遍筛查以检测SARS-CoV-2的存在。进行双变量和多变量逻辑回归分析以确定COVID-19筛查呈阳性的危险因素。
3家机构共有1198例患者接受了术前筛查，其中7例（0.58%）检测出SARS-CoV-2。大多数患者（7例中的6例，86%）无症状。检测呈阳性的患者更有可能是西班牙裔（P=0.046），并且根据美国麻醉医师协会（ASA）身体状况评分，其合并症数量更多（P=0.013）。在多变量分析中，已知的COVID-19阳性接触者被发现是一个显著的危险因素（P=0.004）。
COVID-19术前普遍筛查的早期结果显示发病率较低，无症状患者比例较高。医护人员，尤其是那些感染病毒风险较高的人员，应意识到仅基于症状或旅行史进行筛查的挑战，并考虑对接受择期手术的患者进行普遍筛查。
二级。
