Rapid response in the COVID-19 pandemic: a Delphi study from the European Pediatric Dialysis Working Group

Abstract

Background COVID-19 was declared a global health emergency. Since children are less than 1% of reported cases, there is limited information to develop evidence-based practice recommendations. The objective of this study was to rapidly gather expert knowledge and experience to guide the care of children with chronic kidney disease during the COVID-19 pandemic. Methods A four-round multi-center Delphi exercise was conducted among 13 centers in 11 European countries of the European Pediatric Dialysis Working Group (EPDWG) between March, 16th and 20th 2020. Results were analyzed using a mixed methods qualitative approach and descriptive statistics. Results Thirteen COVID-19 specific topics of particular need for guidance were identified. Main themes encompassed testing strategies and results (n = 4), changes in use of current therapeutics (n = 3), preventive measurements of transmission and management of COVID-19 (n = 3), and changes in standard clinical care (n = 3). Patterns of center-specific responses varied according to regulations and to availability of guidelines. Conclusions As limited quantitative evidence is available in real time during the rapid spread of the COVID-19 pandemic, qualitative expert knowledge and experience represent the best evidence available. This Delphi exercise demonstrates that use of mixed methodologies embedded in an established network of experts allowed prompt analysis of pediatric nephrologists' response to COVID-19 during this fast-emerging public health crisis. Such rapid sharing of knowledge and local practices is Electronic supplementary material The online version of this article (https://doi.essential to timely and optimal guidance for medical management of specific patient groups in multi-country health care systems such as those of Europe and the US.

Countermeasures against COVID-19: how to navigate medical practice through a nascent, evolving evidence base — a European multicentre mixed methods study

“…The methodology of the Delphi exercise conducted among the EPDWG in March 2020 was recently described. 5 This follow-up study examines 14 EPDWG centres from 12 countries (Austria, Belgium, Czech Republic, France, Germany, Greece, Italy, Lithuania, Poland, Spain, Turkey and the UK). Exploration of complex and pluralistic contexts, such as cross-national studies, requires a comprehensive research approach.…”

“…It allows the researcher to gain a better understanding of the research problem by yielding more complete evidence. 8–10 Therefore, individual sets of 52 countermeasures (see ref 5 ) were mailed to each centre to validate countermeasure implementation rates on 20 March, and to assess altered rates on 3 April 2020. Participants were asked whether implementation decisions concerning individual countermeasures were based on expert opinion and/or hospital regulations and/or resource availability.…”

“… 1–4 The European Pediatric Dialysis Working Group (EPDWG) conducted a Delphi exercise over 5 days during the first week of statutory public curfews in 13 paediatric nephrology centres from 11 European countries 5 using ‘crowd intelligence’ to define countermeasures in several relevant response domains, and to assess their implementation rates. 5 Whereas some countermeasures (replacement of routine visits by telephone calls) were widely implemented, others (asymptomatic staff member testing) were rarely implemented, and implementation rates varied widely among countermeasures and centres. 5 This heterogeneity may have reflected country-specific infection rates and pandemic stage-dependent measures to decrease infection rates.…”

“… 5 Whereas some countermeasures (replacement of routine visits by telephone calls) were widely implemented, others (asymptomatic staff member testing) were rarely implemented, and implementation rates varied widely among countermeasures and centres. 5 This heterogeneity may have reflected country-specific infection rates and pandemic stage-dependent measures to decrease infection rates. However, the mechanisms underlying COVID-19 countermeasure implementation by individual centres were not studied.…”

Privacy-Protecting, Reliable Response Data Discovery Using COVID-19 Patient Observations

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents a watershed event in public health and has highlighted numerous opportunities and needs in clinical and public health informatics infrastructure ( 1 – 3 ). One of the key challenges has been the rapid response of analyses and interpretation of observational data to inform clinical decision making and patient expectations, understanding, and perceptions ( 4 – 8 ).…”