Unit of Orthodontics, Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar.
Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
BMC Oral Health. 2022 Jul 27;22(1):310. doi: 10.1186/s12903-022-02340-w.
Globally, with the COVID-19 pandemic, dental services were limited to emergency/ urgent conditions and were provided only after tele-triage referral for face-to-face management. However, no previous research explored whether the pain severity (PS) drives the tele-triage decisions. The current study examined the association between PS and tele-triage decision of whether to manage the condition remotely or refer the caller for face-to-face management.
This retrospective cross-sectional study analyzed the PS reported by hotline callers, using numerical rating scale (NRS-11), during the first wave of COVID-19 lockdown (23 March-31 August 2020) and its association with tele-triage decision controlling for age, sex, history of chronic illness, and dental discipline needed. Binomial logistic regression assessed the association between the PS (exposure) and tele-triage decision (outcome). ANOVA compared PS across tele-triage categories, dental history and tentative diagnosis.
PS was significantly associated with tele-triage decisions (p < 0.05). An increase in pain score by 1 unit was associated with 1.4 times increased odds of face-face referral (95% CI: 1.26-1.54). Pediatric/ adolescent patients (9-18 years) (odds ratio (OR) = 2.07; 95% CI: 1.07-4.02), history of chronic illness (OR = 2.12; 95% CI:1.28-3.51), need for surgical specialty (OR = 1.93; 95% CI: 1.22-3.04) and orthodontic specialty (OR = 7.02; 95% CI: 3.54-13.87) were independently associated with tele-triage decision. PS was highest for the emergency triage category (8.00 ± 2.83, P < 0.0001), dental history of tooth with cavity or filling (6.65 ± 2.024, P < 0.0001), and the tentative tele-diagnosis of cellulitis (7.75 ± 2.872, P < 0.0001).
During COVID-19 pandemic, tele-triage decisions were significantly influenced by patient-reported PS, adjusting for a range of variables. Despite this, referral for face-to-face management was individualized and driven by the tripartite considerations of the reported pain, clinical judgement, and the high transmission characteristics of COVID-19.
在全球范围内，由于 COVID-19 大流行，牙科服务仅限于紧急/紧急情况，并且只有在远程电话分诊后才能进行面对面管理。然而，以前没有研究探讨疼痛严重程度（PS）是否会影响电话分诊决策。本研究检查了 PS 与远程管理或转介呼叫者进行面对面管理的电话分诊决策之间的关联。
这项回顾性的横断面研究使用数字评分量表（NRS-11）分析了热线呼叫者在 COVID-19 封锁第一波期间（2020 年 3 月 23 日至 8 月 31 日）报告的 PS，并控制年龄、性别、慢性病史和所需牙科学科对电话分诊决策的关联。二项逻辑回归评估了 PS（暴露）与电话分诊决策（结局）之间的关联。方差分析比较了电话分诊类别、牙科史和暂定诊断的 PS。
PS 与电话分诊决策显著相关（p<0.05）。疼痛评分增加 1 个单位与面对面转介的几率增加 1.4 倍相关（95%CI：1.26-1.54）。儿科/青少年患者（9-18 岁）（优势比（OR）=2.07；95%CI：1.07-4.02）、慢性病史（OR=2.12；95%CI：1.28-3.51）、需要外科专业（OR=1.93；95%CI：1.22-3.04）和正畸专业（OR=7.02；95%CI：3.54-13.87）与电话分诊决策独立相关。紧急分诊类别的 PS 最高（8.00±2.83，P<0.0001），有龋齿或补牙史的牙齿（6.65±2.024，P<0.0001），暂定的蜂窝织炎电话诊断（7.75±2.872，P<0.0001）。
在 COVID-19 大流行期间，电话分诊决策显著受到患者报告的 PS 影响，同时考虑了一系列变量。尽管如此，面对面管理的转诊仍然是个体化的，并由报告疼痛、临床判断以及 COVID-19 的高传播特征这三个方面的考虑驱动。
