Relationship Between Patient-reported Orofacial-dental Pain Severity and Tele-triage Decisions During COVID-19 Pandemic - Does the Severity of Pain Drive Tele-triage Decisions?

Abstract BACKGROUND: Globally, withCOVID-19 pandemic, elective dental services were stopped, and only urgent/ emergency conditions were managed face-to-face after tele-triage(TT). However, no previous researchexploredwhetherthe severity of orofacial/ dental pain (OFDP)drivesthe TT decisions.The current report undertook this task.METHODS: This retrospective cross-sectional reportanalyzed the pain severity (PS) reported byhotline callers during the first COVID-19 lockdownand its association with patient's age,sex, history of chronic illness,and dental discipline required. PS was also compared across triage categories, associated dental history and tentative tele-diagnosis. PS was measured using self-reported numerical rating scale (NRS-11).Binomial logistic regression assessed the associationbetweenthe PS (exposure) and likelihoodof being referred for face to face management, controlling for age, sex, history of chronic illness, and dental discipline needed. ANOVA compared pain severity (PS) across dental history and tentative diagnosis.RESULTS:PS was significantly associated with TT decisions (p<0.05). An increase in pain score by 1 unit was associated with 1.4 times increased odds of face-face referral. Pediatric/ adolescent patients (9-18 years) were 2.1 times more likely, and those with chronic illness were 2.12 times more likelyto be referred for face-to-facemanagement.Among the dental specialties, surgical and orthodontic specialties were each associated with increased odds of referral (1.9 and 7.016 respectively) compared to restorative specialties.The highest PS was highest for the emergency triage category (8.00 ± 2.83, P< 0.0001),adults (6.29 ± 2.1819, P< 0.0001),and the tentative tele-diagnosis of cellulitis (7.75 ± 2.872, P< 0.0001).CONCLUSIONS: TT decisions were significantly influenced by severity of patient-reported OFDP, adjusting for a range of variables. However, acute dental conditions were not referred when they were judged to be manageable remotely; and conversely, less acute dental conditions were given the attention they required and referred when they hadpotential life threating or quality of life implications. Consideringsuch tele-approach after the pandemic has subsided might be safe and useful in a range of scenarios and healthcare facilities.