The Effects of The Covid-19 Pandemic on Pediatric Orthopaedic Sports Medicine & Arthroscopy: Practice Implications, and The Management and Triaging of Surgical Cases
Bibliographic record
Abstract
Background: The COVID-19 pandemic has had a significant impact on pediatric sports medicine patients. Many surgeons found themselves simultaneously managing surgical pathology, concerns of exposure, and limited resources. This led to challenging decisions regarding relative patient and case urgency. Purpose: 1. Define through expert opinion the relative urgency of prototypical pediatric arthroscopic surgical cases 2. Define current practices regarding pre-surgical testing and findings relevant to the recent, current, and potentially forthcoming challenges inherent to the COVID-19 pandemic. We further gathered information regarding variability of current practices and access to resources. Methods: A mixed-methods survey was performed of the POSNA membership, specific to surgeons identifying as sub-specialized in pediatric sports medicine. A clinical vignette style survey was developed by the POSNA QSVI: Sports Committee. Cases included patients with a: meniscal tear, a bucket handle meniscus tear, ACL tear, unstable osteochondritis dissecans (OCD) lesion of the knee, locked knee due to a loose body, OCD of the capitellum, recurrent and primary shoulder instability, traumatic patellar instability with a loose osteochondral fragment, and a patient with a symptomatic discoid meniscus. The survey further asked how resource limitations could impact surgical decision-making, and how pre-operative testing might impact surgical timing and decisions. Information regarding personal and institutional experiences and limitations during the first 6 months of the pandemic was also collected. Results: There were 119 survey respondents, of whom 54 met inclusion criteria. Seventy-five percent were primarily based at a university or academic hospital. Almost 56% of respondents had all scheduled cases cancelled for 4-7 weeks, 22% for 8-11 weeks, and 17% were shut down for more than 12 weeks. Forty-two percent followed guidance from an orthopaedic governing body, most commonly national orthopaedic organizations. There was significant variation in pre-operative testing protocols, ranging from screening questions to PCR testing and rapid testing. Triaging factors chosen by respondents for determining relative urgency, in order, were: Diagnosis, severity of symptoms/pathology, duration of symptoms, age, activity level, originally planned surgical date, and patient request. Each clinical vignette elicited variability in responses, but each had clear leaders in opinion regarding relative urgency. Most cases had more than 2/3 of respondents in relative agreement with respect to urgency. Conclusion: This study provides comparative details of the challenges and resource limitations experienced in pediatric sports medicine, and provides much-needed sub-specialty opinions on standards with respect to relative urgency and triaging for related cases. These experiences and opinions may be of benefit when advocating for patient access and care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.053 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".