COVID-19 Scientific Advisory Council

University of Colorado Anschutz Medical Campus

Anschutz

COVID-19 Scientific Advisory Council

An Academic-Hospital Partnership

SAC Co-Chairs

In March 2020, the Children's Hospital Colorado's Incident Command Team called for rapid review of the emerging literature for high priority questions, including screening and treatment of children with suspected or confirmed COVID-19 infection and protection of healthcare workers. To achieve this goal, Children's Colorado (CHCO) assembled a team of clinician-scientists by issuing a hospital-wide request for volunteers representing all CHCO clinical and scientific sections.

Soon after the SAC was established, the co-chairs--Drs. Marion Sills (Pediatric Emergency Medicine) and Eva Nozik (Pediatric Critical Care)--met with the hospital's Incident Command Team (ICT) to establish a mission statement:

The mission of the SAC is to advise Children's Hospital Colorado's ICT, faculty providers, and the referring provider community on clinical aspects of the COVID-19 epidemic. The SAC will review existing literature and provide timely feedback on high priority questions to incident command.

Based on input from its members, the SAC mission evolved from purely addressing the needs of the ICT to developing and updating clinical guidance for COVID-19 evaluation and management, as well as aspects of healthcare worker protection that were not already being addressed by other hospital teams.

SAC leadership developed a process map for clarifying the scientific issues, priority-setting, rapid evidence assessment, and reporting findings to the hospital's Incident Command Team. More details about this infrastructure are described in an article in the Journal of Pediatrics highlighting the development and output of the SAC and in an online toolkit for setting up a SAC.

Select a search strategy. Discuss the search strategy with the team that is writing the rapid review. Although it is convenient to search on LitCovid, in order to document a search strategy it is best to use the LitCovid search strategy for COVID-19 on the regular PubMed search site: "coronavirus"[All Fields] OR "ncov"[All Fields] OR "cov"[All Fields] OR "2019-nCoV"[All Fields] OR "COVID-19"[All Fields] OR "SARS-CoV-2"[All Fields]

PubMed help is here and their tutorial page is here. Of the tutorials, these are most helpful to this rapid review process:

PubMed Subject Search

MeSH in MEDLINE/PubMed

Document the search strategy. Hyperlink the search terms you just pasted into the document with the hyperlink to your search. This will allow you and others to re-run this search from the Rapid Evidence Assessment document--the template for this document is available in the SAC Toolkit
If there are PubMed search results of potential relevance to the SAC question, check the box next to each of these. Check the box next to each potentially-relevant article.
Once you’ve selected all of the potentially relevant studies, send them to the clipboard (in the drop-down box under “Send to”. Saving to and then accessing the PubMed Clipboard Then go to the clipboard using the “Clipboard” link immediately below the search box and immediately above the “Send to” box.
In the Clipboard, highlight the hyperlink-containing title of each selected article and copy it. This works better from the Clipboard view than in the Search results.
Paste the hyperlink-containing article title into the Rapid Evidence Assessment document for the question you are researching. This allows the article listing to include the hyperlink right to the article. Immediately following the search strategy, notate the number of articles resulting from the search, the number you found potentially relevant, and the date of your last search update for that string (see example below).
Add an article summary below the article title. The format for summarizing an article is here:
- Citation format: [lead-author last name and first initials]. [journal name or abbreviation] [publication year] - insert a hyperlink to the URL for the article (ideally, the fulltext doi link) Example: Yazdany J. Ann Int Med. 2020.
- Study Features (relevant to the SAC review question): Includes relevant parts of the PICOT framework (not all study features will be identifiable/relevant for every report)
  - Population and Sample (e.g., sample size, remarkable demographics such as age group, comorbidities, patient vs health care worker)
  - Infectious agent (e.g., SARS-CoV-2, SARS-CoV-1, H1N1, etc) and/or Other Condition (e.g., ARDS, cytokine storm)
  - Setting (e.g., country, health system, specialty unit/area such as ICU, nursing or respiratory therapy)
  - Outcome (e.g., infection risk, mortality, disease severity or progression)
  - Exposure(s) (e.g., treatment, device, procedure, test, instrument, equipment, policy, time, other independent variable)
  - Comparator(s) (e.g., placebo control, active control, standard of care, no comparator)
  - Timeframe (e.g., prospective follow-up period) Strength of evidence: Includes type of study, source, and peer review status as described further here.
  - Design (e.g., observational/descriptive, case report, randomized experiment, natural experiment, case-control, systematic review) Source (e.g., peer-reviewed journal, preprint, government publication)
  - Findings (conclusions and recommendations relevant to the SAC review question):
    - Relevant result(s) (e.g., direction and magnitude of treatment effect, relative risk, sensitivity/specificity)
    - Relevant conclusion(s) (e.g., adopt a procedure or instrument, select a treatment given particular circumstances)
Organize the article summaries with headings by either subtopic (e.g., COVID-19-specific article vs other respiratory conditions) or by citation type (e.g., peer reviewed article vs blog posts). A variety of examples of rapid reviews are at Oxford's CEBM COVID-19 site.

SAC COVID-19 Pediatric Guidelines

A link to the full list of pediatric COVID-19 clinical guidance resources from the SAC is here. This link takes you to the AgileMD landing page for the guidance documents and is not compatible with the Internet Explorer browser.

Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease COVID-19

Acute COVID-19 Management Pediatric Pathway

Cardiac Evaluation for Post COVID-19 (SARS-CoV-2) Infection Return to Play in Children and Adolescents

Guidelines for the Prevention and Treatment of Venous Thromboembolism (VTE) in Hospitalized Patients with COVID-19

Care of Tracheostomy and Ventilator Dependent Patients During COVID-19

Convalescent Plasma in Children with COVID-19

Corticosteroid Use in Children with COVID-19

COVID-19 Antiviral Treatment Algorithm

Ibuprofen Use in COVID Patients

Recommendations for immune modulation for critically ill patients with confirmed SARS-CoV2 infection and cytokine storm syndrome (CSS)

Risk of transmission of COVID-19 to an anesthesia provider/surgeon/proceduralist by an asymptomatic patient who tested COVID (-) that morning/day

MIS Surgery: Strategies to Prevent COVID19 Transmission in the OR