Triage of Amyotrophic Lateral Sclerosis Patients during the COVID-19 Pandemic: An Application of the D50 Model.
Triage of Amyotrophic Lateral Sclerosis Patients during the COVID-19 Pandemic: An Application of the D50 Model.
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DOI：
10.3390/jcm9092873
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发表时间：
2020-09-05
影响因子：
3.9
通讯作者：
Grosskreutz J
中科院分区：
文献类型：
--
作者：
Steinbach R;Prell T;Gaur N;Stubendorff B;Roediger A;Ilse B;Witte OW;Grosskreutz J
肌萎缩侧索硬化症（ALS）是一种进行性神经肌肉疾病，其治疗需要持续提供多学科治疗。由于新型冠状病毒病（COVID-19）大流行，我们中心与 ALS 患者的定期接触受到严格限制，患者护理因支持治疗的延迟而面临风险。我们建立了基于 D50 疾病进展模型的分诊系统，从而能够识别具有高疾病侵袭性的前瞻性队列（D50 < 30）。 37 名患有高度侵袭性疾病的患者根据其特定疾病的需求和能力，通过电话或现场积极进行随访。我们在此描述了 2020 年 3 月至 6 月期间因 COVID-19 造成的限制期间这些有先见之明的努力的程序、障碍和结果。总而言之，四名患有高度侵袭性疾病的患者开始接受无创通气，两名患者接受了胃造口术。我们可以证明，在 COVID-19 爆发前一年的相似时间段内，在回顾性队列中诱导了相当数量的高级护理。我们通过 D50 模型指标识别高风险患者的工作流程可以在现有中心内轻松实施和集成。它有助于为我们的 ALS 患者维持高质量的高级护理计划。
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease, the management of which requires the continuous provision of multidisciplinary therapies. Owing to the novel coronavirus disease (COVID-19) pandemic, regular contact with ALS patients at our center was severely restricted and patient care was at risk by delay of supportive therapies. We established a triage system based on the D50 disease progression model and were thus able to identify a prospective cohort with high disease aggressiveness (D50 < 30). Thirty-seven patients with highly aggressive disease were actively offered follow-up, either via telephone or on-site, depending on their disease-specific needs and abilities. We describe here the procedures, obstacles, and results of these prescient efforts during the restrictions caused by COVID-19 in the period between March and June 2020. In conclusion, four patients with highly aggressive disease were initiated with non-invasive ventilation and two received a gastrostomy. We could show that a comparable amount of advanced care was induced in a retrospective cohort within a similar time period one year prior to the COVID-19 outbreak. Our workflow to identify high-risk patients via D50 model metrics can be easily implemented and integrated within existing centers. It helped to maintain a high quality of advanced care planning for our ALS patients.
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