Triage of Neurosurgery Cases During the COVID-19 Pandemic
President, Saudi Association of Neurological Surgery (SANS)
Associate Professor and Head, Division of Neurosurgery Department of Surgery, College of Medicine
King Saud University
Riyadh, Saudi Arabia
Epidemics secondary to spreading infections are known to present a challenge to healthcare systems. Providing adequate medical treatment to individuals falling sick to the new infection becomes a priority in many hospitals. On the other hand, providing medical care to sick people with illnesses other than the spreading infection could become a challenge. Since the newly identified COVID-19 virus became recognized as a pandemic on March 11, 2020, health care systems across the globe have taken measures to limit the spread of the virus.1
Given the unique nature of neurosurgical conditions, as many require an urgent or emergency intervention, it was necessary to have a system in place to triage neurosurgery cases. It will serve as a guide for health care providers to be able to provide the necessary care while limiting the spread of the infection to the patients and/or hospital staff. It is expected that the recommendations might differ from one country to another based on the local circumstances and disease conditions. The Saudi Association of Neurological surgeons (SANS), among many other neurosurgical societies worldwide,2,3 has commissioned a consortium of qualified and practicing neurosurgeons who developed a consensus statement to triage neurosurgery cases (Table1).4 Cases were classified into four color-coded categories based on the priority of the required neurosurgical intervention. It is recommended that healthcare providers would practice their judgment on individual cases while considering the triage recommendations as a guide.
It has to be emphasized that hospital recommendations for personal protective measures against the spread on the virus should be strictly followed. While social distancing recommendations are being followed, many neurosurgical services have developed a system of virtual online communication to ensure adequate and continuous patient care and education among team members are carried out.5 By sharing the triage statement, we hope that the readers would find it helpful and beneficial to their practice.
Table 1. Prioritization of neurosurgical cases based on color domains and priority categories
* Patients must be treated as soon as possible, ** Patients can be treated up to/within 48 hours.
Immediate: Acute life-threatenin condition that needs immediate attention*
Within 24 h: Loss of life or significant function that can be saved by intervention within 24 h
Functional and epilepsy:
Life or significant functional loss that can be saved by intervention within 1 week.
Functional and epilepsy surgery:
Peripheral nerve surgery:
Cases where life or significant function would not be affected by waiting for more than 4 weeks