Recommendations for the Care of Pediatric Orthopaedic Patients During the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has necessitated modifications to pediatric orthopaedic practice to protect patients, families, and healthcare workers and to minimize viral transmission. It is critical to balance the benefits of alterations to current practice to reduce the chances of COVID-19 infection, with the potential long-term impact on patients. Early experiences of the pandemic from orthopaedic surgeons in China, Singapore, and Italy have provided the opportunity to take proactive and preventive measures to protect all involved in pediatric orthopaedic care. These guidelines, based on expert opinion and best available evidence, provide a framework for the management of pediatric orthopaedic patients during the COVID-19 pandemic. General principles include limiting procedures to urgent cases such as traumatic injuries and deferring outpatient visits during the acute phase of the pandemic. Nonsurgical methods should be considered where possible. For patients with developmental or chronic orthopaedic conditions, it may be possible to delay treatment for 2 to 4 months without substantial detrimental long-term impact.

Effect of the COVID-19 Outbreak on Pediatric Patients’ Admissions to the Emergency Department in an Italian Orthopedic Trauma Hub

“…During COVID-19 pandemic, with parks closed recent spike in purchase of home play equipment and trampolines has been registered. Consequently, the lockdown per se did not prevent all injuries [9].…”

“…This nding is probably due to the fact that younger children are less aware of the risks of injury and they probably have an experimental behavior. Farrell et al [9] reported that during the SARS outbreak in 2003, ER visits declined by 21% (95% CI, 18%-24%) over the 4-week study period.…”

COVID-19. An update for orthopedic surgeons

“…Delays of operative intervention in elective cases although temporary, might extend for months as a best estimate. Patients should be offered sound alternatives to assist them bear the anticipated waiting times, this could be in the form of optimized medical treatment, individualized non-surgical options through multidisciplinary approaches, supportive online counseling, psychological support, and in pediatric patients engaging families and stressing on safety measures [40][41][42].…”

Recommendations from the Italian Society of Pediatric Orthopaedics and Traumatology for the management of pediatric orthopaedic patients during the COVID19 pandemic and post-pandemic period in Italy

“…In any case, telemedicine must be encouraged whenever possible. Follow up imaging should be taken near the locality of the patient and e-mailed to the institute, only if likely to make a significant change to care [7,8].…”

“…In case of elective surgery, a strict priority must be maintained in the waiting list, especially if the duration of the pandemic period cannot be precisely estimated [7,8]. The Advisory Board of the SITOP has provided a panel of priority levels in order to safely schedule deferrable surgical treatments, reducing the risk of missing children who require non postponable operations, during the pandemic and post peak period (see Table 2).…”