Letter: Neurosurgical Triage in the Pandemic Era

Abstract

Catastrophic events disrupt the neurosurgeon's ability to provide clinical care. Events such as natural disaster, mass casualty, war, and even pandemic, constitute humanitarian emergencies that threaten every aspect of care delivery. Neurosurgeons may face shortages of critical resources, including access to surgical supplies, staff, operating rooms, and intensive care beds. Accordingly, neurosurgeons are forced into the difficult position of deciding how to deploy essential resources when supply is insufficient to cover the demand. This is known as neurosurgical triage.Triage is a key principle in the medical management of disasters. Yet, despite the obvious life-saving implications, there is no universal agreement on how neurosurgical patients should be triaged. Further, existing triage algorithms focus on initial field assessments of patients, well before neurosurgeons are consulted.Here we consider neurosurgical triage drawing upon insights from military and emergency medicine to create principles specific to our patient population facing disaster scenarios. Appreciating the implications of triage during resource scarcity will become an essential skill for neurosurgeons.

Effects of the COVID-19 Pandemic on Everyday Neurosurgical Practice in Alsace, France: Lessons Learned, Current Perspectives, and Future Challenges—Preliminary Results of a Longitudinal Multicentric Study Registry

“…Our approach involved achieving a team consensus on finding the optimal balance between practical decisions and the ideal adherence to state-of-the-art practices. The primary objective was to deliver high-quality care without compromising standards through the strict implementation of military triage practices [ 31 , 32 , 33 , 34 , 35 ].…”

“…), and the Glasgow Coma Scale (GCS) [ 31 ] for traumas. For subarachnoid hemorrhage cases, the World Federation of Neurosurgical Societies (WFNS) score [ 32 ] was noted, while neuro-oncology cases included the Karnofsky Prognostic Scale (KPS) and the therapeutic strategy (biopsy/surgical removal). These endpoints were compared with analogous data available from a matching cohort selected from the institutional pre-pandemic historical database.…”

Managing Neurosurgery in the Covid-19 Pandemic

“…The implementation of the Group decision-making of neurosurgery operation was a great help in order to observe justice and select patients for performing surgery (11,16,17,23,26). Also, an ethical guide for hospitalization of patients in neurosurgery wards was developed where patients' age, type of surgery, condition and deterioration were considered (22,23).…”

“…Also, as speci ed in instructions, after performing the necessary screening tests (22), the patients underwent surgeries by observing health standards.…”