What best practices can pediatric otolaryngologists adopt to provide effective care for their COVID-19 patients and ensure safety for themselves, other healthcare workers, and their patients?
Bottom Line: Recommended best practices for pediatric otolaryngologists treating COVID-19 patients must emphasize judicious allocation of care for severe conditions while ensuring patient, physician, and healthcare worker safety.
Background: Although children appear relatively resistant to the COVID-19 virus, patients < 5 years of age are more likely to develop severe or critical symptoms. Moreover, patients with mild or asymptomatic cases may still be highly contagious, and otolaryngologists are at increased risk for contracting COVID-19.
Study design: Data study.
Setting: Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, Penn.
Synopsis: Authors examined data derived from peer-reviewed primary literature and published guidelines from national or international medical organizations to develop a consensus of practice guidelines for pediatric otolaryngologists. Guidelines discuss infection control precautions with a working premise that, given the frequent asymptomatic presentation of COVID-19 in children, all pediatric patients with unknown COVID-19 status, regardless of age, should be presumed positive until proven otherwise. Authors cite the AAO-HNS recommendation limiting care to time-sensitive and emergent problems to reduce nosocomial transmission and CMS’ tiered system for triage, providing examples related to pediatric otolaryngology. They enumerate safety measures such as presurgical COVID-19 testing, optimal use of PPE, and operating room preparations. Tables of guidelines classify otolaryngologic conditions seen in children and recommend protocols for surgical and nonsurgical diagnostic and interventional procedures. Limitations include the rapidly changing knowledge about COVID-19 effects in pediatric patients. Authors state that, although the full repercussions of COVID-19 have yet to be realized, these recommendations should guide pediatric otolaryngologists in providing effective care while maintaining safety.
Citation: Bann DV, Patel VA, Saadi RA, et al. Best practice recommendations for pediatric otolaryngology during the COVID-19 pandemic [published online ahead of print April 28, 2020]. Otolaryngol Head Neck Surg. doi:10.1177/0194599820921393.