Allocating Medical Resources in the Time of Covid-19

Brown, Matthew J.; Goodwin, Justin

doi:10.1056/nejmc2009666

Cited by 42 publications

(21 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In other words, an unprecedentedly dramatic experience has taken place in which, due to compressed temporality, exacerbated emotional factors and massive influx of patients, a choice in the sorting cursor is made to the detriment of a reasoned strategy. Such a situation is likely to contradict our caregiving-based ethical values [12]. Indeed, in addition to the elements linked to the lack of available beds, several factors in the decisionmaking process were sources of concern: reduction of the minimum time necessary to make such occasionally "life-or-death" decisions, decrease due to containment measures in the essential time to be spent with relatives and pressure from the continuous flow of arriving ICU patients.…”

Section: Modification Of Admission or Non-admission Strategies (Triage)mentioning

confidence: 99%

Ethical dilemmas due to the Covid-19 pandemic

Robert

Kentish‐Barnes

Boyer

et al. 2020

Ann. Intensive Care

244

234

View full text Add to dashboard Cite

The devastating pandemic that has stricken the worldwide population induced an unprecedented influx of patients in ICUs, raising ethical concerns not only surrounding triage and withdrawal of life support decisions, but also regarding family visits and quality of end-of-life support. These ingredients are liable to shake up our ethical principles, sharpen our ethical dilemmas, and lead to situations of major caregiver sufferings. Proposals have been made to rationalize triage policies in conjunction with ethical justifications. However, whatever the angle of approach, imbalance between utilitarian and individual ethics leads to unsolvable discomforts that caregivers will need to overcome. With this in mind, we aimed to point out some critical ethical choices with which ICU caregivers have been confronted during the Covid-19 pandemic and to underline their limits. The formalized strategies integrating the relevant tools of ethical reflection were disseminated without deviating from usual practices, leaving to intensivists the ultimate choice of decision.

show abstract

Section: Modification Of Admission or Non-admission Strategies (Triage)mentioning

confidence: 99%

Ethical dilemmas due to the Covid-19 pandemic

Robert

Kentish‐Barnes

Boyer

et al. 2020

Ann. Intensive Care

244

234

View full text Add to dashboard Cite

show abstract

“…The high prevalence of obesity, type 2 diabetes and other chronic diseases, in addition with socioeconomic disparities, unequal access to prompt medical attention, and a lack of sufficient health infrastructure pose intense challenges in the public health care system in Mexico [5,6]. As the disease continues to spread locally, the implementation of clinical tools to assess those patients with a higher risk for complications and lethality are needed [7,8]. Recently, some predictive scores have been proposed and validated for COVID-19 in a hospital care setting, especially to predict critical illness hospitalization, intense care unit (ICU) admission, and mechanical ventilation support.…”

Section: Introductionmentioning

confidence: 99%

Validation and repurposing of the MSL-COVID-19 score for prediction of severe COVID-19 using simple clinical predictors in a triage setting: The Nutri-CoV score

et al. 2020

View full text Add to dashboard Cite

Background During the COVID-19 pandemic, risk stratification has been used to decide patient eligibility for inpatient, critical and domiciliary care. Here, we sought to validate the MSL-COVID-19 score, originally developed to predict COVID-19 mortality in Mexicans. Also, an adaptation of the formula is proposed for the prediction of COVID-19 severity in a triage setting (Nutri-CoV). Methods We included patients evaluated from March 16th to August 17th, 2020 at the Instituto Nacional de Ciencias Médicas y Nutrición, defining severe COVID-19 as a composite of death, ICU admission or requirement for intubation (n = 3,007). We validated MSL-COVID-19 for prediction of mortality and severe disease. Using Elastic Net Cox regression, we trained (n = 1,831) and validated (n = 1,176) a model for prediction of severe COVID-19 using MSL-COVID-19 along with clinical assessments obtained at a triage setting. Results The variables included in MSL-COVID-19 are: pneumonia, early onset type 2 diabetes, age > 65 years, chronic kidney disease, any form of immunosuppression, COPD, obesity, diabetes, and age <40 years. MSL-COVID-19 had good performance to predict COVID-19 mortality (c-statistic = 0.722, 95%CI 0.690–0.753) and severity (c-statistic = 0.777, 95%CI 0.753–0.801). The Nutri-CoV score includes the MSL-COVID-19 plus respiratory rate, and pulse oximetry. This tool had better performance in both training (c-statistic = 0.797, 95%CI 0.765–0.826) and validation cohorts (c-statistic = 0.772, 95%CI 0.0.745–0.800) compared to other severity scores. Conclusions MSL-COVID-19 predicts inpatient COVID-19 lethality. The Nutri-CoV score is an adaptation of MSL-COVID-19 to be used in a triage environment. Both scores have been deployed as web-based tools for clinical use in a triage setting.

show abstract

“…The distribution should be made in such a way that the greatest possible number of lives can be saved. Urgency and prospects of treatment success are important and critically discussed criteria for making this difficult decision [17][18][19]. End of life decisions are part of a doctor's everyday medical experience.…”

Section: Lack Of Resources and Mass Critical Carementioning

confidence: 99%

Hospital preparedness for mass critical care during SARS-CoV-2 pandemic

et al. 2020

View full text Add to dashboard Cite

Mass critical care caused by the severe acute respiratory syndrome corona virus 2 pandemic poses an extreme challenge to hospitals. The primary goal of hospital disaster preparedness and response is to maintain conventional or contingency care for as long as possible. Crisis care must be delayed as long as possible by appropriate measures. Increasing the intensive care unit (ICU) capacities is essential. In order to adjust surge capacity, the reduction of planned, elective patient care is an adequate response. However, this involves numerous problems that must be solved with a sense of proportion. This paper summarises preparedness and response measures recommended to acute care hospitals.

show abstract

Allocating Medical Resources in the Time of Covid-19

Cited by 42 publications

References 8 publications

Ethical dilemmas due to the Covid-19 pandemic

Ethical dilemmas due to the Covid-19 pandemic

Validation and repurposing of the MSL-COVID-19 score for prediction of severe COVID-19 using simple clinical predictors in a triage setting: The Nutri-CoV score

Hospital preparedness for mass critical care during SARS-CoV-2 pandemic

Contact Info

Product

Resources

About