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Effectiveness of Preoperative Symptom Screening in Identifying Pediatric SARS-CoV-2 Infections: A Retrospective
Catherine T McNamara1, Laura C Nuzzi1, Ava G White1
1Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Insights
Preoperative symptom screening is ineffective for identifying pediatric COVID-19 cases. Implementing testing protocols is crucial for detecting the virus in children undergoing surgery.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Anesthesiology
Background:
- Lack of evidence-based protocols for identifying COVID-19 in pediatric surgical patients.
- COVID-19 remains a significant threat to children's health.
Purpose of the Study:
- To evaluate the effectiveness of preoperative COVID-19 symptom screening in pediatric patients.
- To assess the prevalence and characteristics of COVID-19 in children undergoing surgery.
Main Methods:
- Retrospective cohort study of pediatric surgical cases (April-June 2020).
- Analysis of hospital billing and medical records for procedures and COVID-19 (SARS-CoV-2) test results.
- Descriptive and bivariate analyses of demographic, procedural, symptom, and test data.
Main Results:
- 0.5% COVID-19 positivity rate among 2900 pediatric surgical cases.
- Most COVID-19 positive cases (92.9%) were asymptomatic.
- Symptom screening did not effectively identify positive cases; older age and minority/lower socioeconomic status were associated with higher positivity.
Conclusions:
- Preoperative symptom screening is insufficient for detecting COVID-19 in pediatric surgical patients.
- Testing protocols are essential during outbreaks to identify infected children.
- Further research needed on other variants and health disparities in pediatric COVID-19.
Abstract:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
