Universal Screening for COVID-19 in Children Undergoing Orthopaedic Surgery: A Multicenter Report
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Todd J Blumberg1, Adam C Adler2, Elaina E Lin3
1Department of Orthopedics and Sports Medicine, Seattle Children's Hospital.
Insights
Universal preoperative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric orthopaedic surgery patients revealed a low incidence of infection. Most positive cases were asymptomatic, highlighting the need for universal screening beyond symptom-based detection.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Public Health
Background:
- The COVID-19 pandemic necessitated changes in surgical protocols to protect patients and healthcare workers.
- Universal preoperative screening for SARS-CoV-2 was implemented as a key safety measure.
- This study specifically investigated its impact on pediatric orthopaedic surgery patients.
Purpose of the Study:
- To determine the incidence and characteristics of SARS-CoV-2 infection in children undergoing orthopaedic surgery.
- To identify risk factors associated with positive COVID-19 screening in this population.
- To evaluate the effectiveness of universal preoperative screening.
Main Methods:
- Retrospective cohort study at 3 pediatric tertiary care centers (March-June 2020).
- Universal nasopharyngeal swab screening for SARS-CoV-2 in 1198 pediatric patients.
- Bivariate and multivariate logistic regression to identify risk factors for positive screening.
Main Results:
- A low incidence of 0.58% (7/1198) SARS-CoV-2 positivity was observed.
- The majority of positive cases (86%) were asymptomatic.
- Hispanic ethnicity, increased medical comorbidities (ASA score), and known COVID-19 contact were significant risk factors.
Conclusions:
- Universal preoperative screening for COVID-19 in pediatric orthopaedic surgery shows a low incidence with a high rate of asymptomatic infections.
- Relying solely on symptoms or travel history for screening is insufficient.
- Universal screening is recommended for patients undergoing elective surgery, especially for healthcare professionals' safety.
Background:
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.
Methods:
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.
Results:
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).
Conclusions:
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 Of Evidence:
Level II.
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