CHICAGO (May 27, 2020): As health care providers observe Coronavirus Disease 2019 (COVID-19) affecting children differently than adults, pediatric surgeons in Chicago have modified an evaluation tool for use in pediatric patients that allows surgeons in every pediatric specialty to prioritize nonemergency ("elective") operations during all phases of the pandemic. The new pediatric-specific scoring system is presented in an "article in press" on the Journal of the American College of Surgeons (JACS) website ahead of print.

Called the Pediatric Medically Necessary Time-Sensitive, or pMeNTS, scoring system, the new index score created by researchers at The University of Chicago (UChicago) Medicine adapts the adult MeNTS approach. That original surgical prioritization approach was published on April 9 in a scientific article on the JACS website amid COVID-19-related resource constraints and nationwide recommendations to postpone elective operations.

Pediatric surgeons at UChicago Medicine found that the adult MeNTS scoring system needed revisions for optimal use in pediatric surgery, according to Mark B. Slidell, MD, MPH, FACS, the lead investigator and associate professor of surgery at UChicago Medicine.
"It was very important to create a pediatric-specific system that recognizes there are big differences between adults and children," Dr. Slidell said.

Need for revised scoring system
Among the differences is that many children testing positive for COVID-19 appear asymptomatic (have no symptoms).2 Also, recent reports noted a new serious complication of COVID-19 in some infected children, including those who were unaware they had the virus: an inflammatory syndrome that can lead to severe involvement of multiple organs.

Dr. Slidell's coauthor, Grace Z. Mak, MD, FACS, UChicago Medicine associate professor of pediatrics and surgery, said users of the pMeNTS scoring worksheet can adapt it to include new COVID-19 developments.

"Part of what we took into account is that asymptomatic COVID-positive patients in the pediatric population could very well have a worse outcome, and multisystem organ failure is a good example," Dr. Mak said.

As the pandemic changes the concept of elective operations, pMeNTS focuses on an operation's medical necessity and time-sensitivity--the effect of treatment delay on the patient's disease. Plus, it assesses COVID-19 factors such as infection risk for the patient and providers as well as projected use of hospital resources, including protective gear, beds, blood products, and staffing. The tool, which Dr. Slidell emphasizes is not a risk calculator, systematically evaluates factors related to the procedure, the patient's disease, and the patient's individual risks. Users rate each factor on a five-point scale and total the scores. A lower overall pMeNTS score indicates a more favorable surgical risk, less risk to personnel, and less resource utilization, and can be used to determine a higher priority for the procedure.

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