An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidenced based medicine’?

Guest, Tod; Tantam, G.; Donlin, Nicola; Tantam, Kate; McMillan, Helen; Tillyard, Andrew

doi:10.1111/j.1365-2044.2009.06084.x

Cited by 47 publications

(46 citation statements)

References 17 publications

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“…The admission STSS (Table 3) and initial SOFA (Table 4) scores were calculated and compared against actual mortality, need for ICU admission, and need for MV. The performance of STSS and SOFA in our subset is compared with the figures quoted in the original reports [9,13], in which the ROC AUC results were used to assess the performance of the individual score groupings.…”

Section: Resultsmentioning

confidence: 99%

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The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis

Adeniji

Cusack

2011

Crit Care

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IntroductionTriage protocols are only initiated when it is apparent that resource deficits will occur across a broad geographical area despite efforts to expand or acquire additional capacity. Prior to the pandemic the UK Department of Health (DOH) recommended the use of a staged triage plan incorporating Sepsis-related Organ Failure Assessment (SOFA) developed by the Ontario Ministry of Health to assist in the triage of critical care admissions and discharges during an influenza outbreak in the UK. There are data to suggest that had it been used in the recent H1N1 pandemic it may have led to inappropriate limitation of therapy if surge capacity had been overwhelmed.MethodsWe retrospectively reviewed the performance of the Simple Triage Scoring System (STSS) as an indicator of the utilization of hospital resources in adult patients with confirmed H1N1 admitted to a university teaching hospital. Our aim was to compare it against the staged initial SOFA score process with regards to mortality, need for intensive care admission and requirement for mechanical ventilation and assess its validity.ResultsOver an 8 month period, 62 patients with confirmed H1N1 were admitted. Forty (65%) had documented comorbidities and 27 (44%) had pneumonic changes on their admission CXR. Nineteen (31%) were admitted to the intensive care unit where 5 (26%) required mechanical ventilation (MV). There were 3 deaths. The STSS group categorization demonstrated a better discriminating accuracy in predicting critical care resource usage with a receiver operating characteristic area under the curve (95% confidence interval) for ICU admission of 0.88 (0.78-0.98) and need for MV of 0.91 (0.83-0.99). This compared to the staged SOFA score of 0.77 (0.65-0.89) and 0.87 (0.72-1.00) respectively. Low mortality rates limited analysis on survival predictions.ConclusionsThe STSS accurately risk stratified patients in this cohort according to their risk of death and predicted the likelihood of admission to critical care and the requirement for MV. Its single point in time, accuracy and easily collected component variables commend it as an alternative reproducible system to facilitate the triage and treatment of patients in any future influenza pandemic.

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Section: Resultsmentioning

confidence: 99%

“…The clinical course of H1N1 pandemic influenza has not occurred as expected. As data has become accessible, reports suggest that SOFA score may not be a good discriminator of outcome in this cohort of patients [12,13]. Thus, its suitability as a means to assist in the triage of H1N1 patients has been called into question.…”

Section: Introductionmentioning

confidence: 99%

The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis

Adeniji

Cusack

2011

Crit Care

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“…This plan used the SOFA score combined with a list of inclusion and exclusion criteria for admission to the critical care unit as a triage tool to complement clinical judgment. Nevertheless, Guest et al [21 ] found that applying the SOFA triage criteria to a current case-mix would result in 116 of the 255 patients (46%) admitted during the study period being denied intensive care treatment they would have otherwise received, of which 45 (39%) survived to hospital discharge. The conclusion was that the proposed triage tool failed adequately to prioritize patients who would benefit from intensive care.…”

Section: Triagementioning

confidence: 99%

Admission and discharge of critically ill patients

Capuzzo

Moreno

Alvisi

2010

Current Opinion in Critical Care

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“…Findings of a recent pilot study suggest that the application of a SOFA-based critical care triage protocol could direct scarce resources to patients who are most likely to benefit from them and increase resource availability [28]. However, another study did not share this finding [29]. …”

Section: Concepts Of Operationsmentioning

confidence: 99%

Chapter 7. Critical care triage

et al. 2010

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Purpose To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage. Methods Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including critical care triage. Results Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resources; (2) developing fair and equitable policies may require restricting ICU services to patients most likely to benefit; (3) usual treatments and standards of practice may be impossible to deliver; (4) ICU care and treatments may have to be withheld from patients likely to die even with ICU care and withdrawn after a trial in patients who do not improve or deteriorate; (5) triage criteria should be objective, ethical, transparent, applied equitably and be publically disclosed; (6) trigger triage protocols for pandemic influenza only when critical care resources across a broad geographic area are or will be overwhelmed despite all reasonable efforts to extend resources or obtain additional resources; (7) triage of patients for ICU should be based on those who are likely to benefit most or a ‘first come, first served’ basis; (8) a triage officer should apply inclusion and exclusion criteria to determine patient qualification for ICU admission. Conclusions Judicious planning and adoption of protocols for critical care triage are necessary to optimize outcomes during a pandemic.

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An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidenced based medicine’?

Cited by 47 publications

References 17 publications

The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis

The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis

Admission and discharge of critically ill patients

Chapter 7. Critical care triage

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