McNamara Catherine T, Nuzzi Laura C, White Ava G, Massey Gabrielle G, Miller Stephanie D, Taghinia Amir H, Labow Brian I
Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2022 Jun 10;10(6):e4402. doi: 10.1097/GOX.0000000000004402. eCollection 2022 Jun.
Evidence-based protocols identifying COVID-19 cases in pediatric preoperative settings are lacking. With COVID-19 positioned to remain a threat to children, this study examines effectiveness of preoperative COVID-19 symptom screening in pediatric patients.
This retrospective cohort study included hospital billing/medical record queries of (1) procedures performed under conscious sedation/general anesthesia and (2) laboratory-confirmed COVID-19 (+) cases from April 6, 2020, to June 15, 2020. Descriptive analyses were performed for demographic, procedural, symptom, and COVID-19 test result data obtained from medical records. Bivariate analyses examined associations between SARS-CoV-2 test results and symptom, demographic, and procedural data.
Among 2900 surgical cases, median (interquartile range) age was 8.1 (12.8) years. The majority were male (n = 1609, 55.5%), white (n = 1614, 55.7%), and not Hispanic/Latino (n = 1658, 57.2%). Additionally, 85.4% (n = 2412) of cases were non-emergent. Fifteen COVID-19 (+) cases were identified, for a 0.5% positivity rate. COVID-19 positivity was not associated with sex, American Society of Anesthesiologists physical status, or preoperative symptom status. Notably, 92.9% (n = 13) of COVID-19 (+) cases were asymptomatic. COVID-19 (+) patients were significantly older (15.6 years) than COVID-19 (-) patients (8.0 years). Patients who were not white, were Hispanic/Latino, or had a relatively lower economic status, were more likely to test positive.
Preoperative symptom screenings insufficiently identified COVID-19 (+) patients. During outbreaks, testing protocols should be implemented to identify COVID-19 (+) patients. Future research should examine if observations are similar for other variants, and how health disparities associate with COVID-19.
缺乏基于证据的在儿科术前环境中识别新冠病毒病（COVID-19）病例的方案。鉴于COVID-19持续对儿童构成威胁，本研究探讨了儿科患者术前COVID-19症状筛查的有效性。
这项回顾性队列研究包括对2020年4月6日至2020年6月15日期间（1）在清醒镇静/全身麻醉下进行的手术以及（2）实验室确诊的COVID-19阳性病例的医院计费/病历查询。对从病历中获取的人口统计学、手术、症状和COVID-19检测结果数据进行描述性分析。双变量分析检查了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测结果与症状、人口统计学和手术数据之间的关联。
在2900例手术病例中，年龄中位数（四分位间距）为8.1（12.8）岁。大多数为男性（n = 1609，55.5%）、白人（n = 1614，55.7%）且非西班牙裔/拉丁裔（n = 1658，57.2%）。此外，85.4%（n = 2412）的病例为非急诊手术。确定了15例COVID-19阳性病例，阳性率为0.5%。COVID-19阳性与性别、美国麻醉医师协会身体状况或术前症状状态无关。值得注意的是，92.9%（n = 13）的COVID-19阳性病例无症状。COVID-19阳性患者（15.6岁）比COVID-19阴性患者（8.0岁）年龄显著更大。非白人、西班牙裔/拉丁裔或经济状况相对较低的患者检测呈阳性的可能性更大。
术前症状筛查未能充分识别出COVID-19阳性患者。在疫情暴发期间，应实施检测方案以识别COVID-19阳性患者。未来的研究应探讨对于其他变种观察结果是否相似，以及健康差异如何与COVID-19相关联。
