The hospital's surgical department leaders review the assigned scores for each surgical case and can shift the scoring cutoff each day for high-priority operations depending on available resources, Dr. Mak stated.
Unlike the adult scoring system, pMeNTS accounts for chronic diseases of childhood and birth defects such as prematurity or congenital heart and lung diseases that may raise susceptibility to more severe COVID-19 infection. It omits chronic illnesses of adulthood that are rare in children such as coronary artery disease and chronic obstructive pulmonary disease.
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Another key change was pediatric age brackets reflecting the impact of age on a procedure. For instance, Dr. Mak said a hernia repair is a more difficult operation in a premature infant than a 14-year-old patient. In the adult MeNTS system, both patients would have the same score, but pMeNTS accounts for the child's age and assigns the infant a higher number, she explained.
Testing the system
The investigators tested pMeNTS in 101 pediatric patients scheduled for operations at UChicago Comer Children's Hospital from March 23 to April 19. In the article, they reported the system to be "a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures."
During that month, they analyzed a sample of 53 deferred cases and 48 cases that were allowed to proceed as scheduled. Procedures they deemed time-sensitive included cancer biopsies and operations needed for discharge from the intensive care unit (ICU), thus freeing ICU beds, Dr. Mak said.
The researchers also compared scores of a sample of 21 patients using both the pediatric and adult scoring systems. Most children, they found, had higher scores with the adult MeNTS. Dr. Slidell said pMeNTS successfully captured the various factors that are unique to children.
Strengths of the pMeNTS tool, according to Dr. Slidell, include the flexibility to adapt to changes in the health care system now and during recovery from the pandemic. Because the tool received input from many different specialists, he said it works well across various pediatric surgical subspecialties.
The transparency of the pMeNTS tool has reduced surgeons' moral dilemmas in the difficult decision-making process of which sick children can proceed with their scheduled operations, Dr. Slidell noted.
He said, "This is one of the most important questions to ask any time we are scheduling a procedure during a time like this: 'Am I making the best decision with the information I have for the patient, for the hospital, for the workers in the hospital, and for the community at large?'"
