Development of a triage protocol for critical care during an influenza pandemic

Christian, Michael D.; Hawryluck, Laura; Wax, Randy S.; Cook, Tim; Lazar, Neil M.; Herridge, Margaret S.; Muller, Matthew P.; Gowans, Douglas R.; Fortier, Wendy; Burkle, Frederick M.

doi:10.1503/cmaj.060911

Cited by 335 publications

(379 citation statements)

References 37 publications

(20 reference statements)

Supporting

Mentioning

344

Contrasting

Unclassified

Order By: Relevance

“…Christian's triage process [6] consists of four components, applied in the following order: 1 Inclusion criteria that make a patient potentially eligible for ICU. 2 Exclusion criteria that automatically exclude a patient from receiving ICU.…”

Section: Methodsmentioning

confidence: 99%

“…One method that has gained significant support from various national (North American [4] and UK [5]) consensus groups is the triage criteria developed by Christian et al [6] in Canada. This applies inclusion criteria (the need for either respiratory support or vasopressors) and then applies exclusion criteria based on certain comorbidities and on age, to all patients considered for ICU care.…”

mentioning

confidence: 99%

“…The triage criteria are designed to be applied to all patients being considered for ICU admission, regardless of aetiology (trauma, surgical, medical, influenza) [6]. The purpose of this study (during the absence of a pandemic) was to apply the criteria to all ICU admissions, to assess their potential impact on 'non-influenza' patients who would still be expected to need ICU during a pandemic and who normally receive ICU care.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Guest¹,

Tantam

Donlin³

et al. 2009

Anaesthesia

View full text Add to dashboard Cite

SummaryWe assessed the impact of a United Kingdom government‐recommended triage process, designed to guide the decision to admit patients to intensive care during an influenza pandemic, on patients in a teaching hospital intensive care unit. We found that applying the 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. In turn, 69% of those categorised as too ill to warrant admission according to the criteria survived. The sensitivity and specificity of the triage category at ICU admission predicting mortality was 0.29 and 0.84, respectively. If the need for intensive care beds is estimated to be 275 patients per week, the triage criteria would not exclude enough patients to prevent the need for further rationing. We conclude that the proposed triage tool failed adequately to prioritise patients who would benefit from intensive care.

show abstract

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Guest¹,

Tantam

Donlin³

et al. 2009

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…This is seldom invasively measured but is usually taken as the time at which the patient starts to exhale increasing amounts of carbon dioxide (VeCO 2 ) to compensate for a build up of lactic acid and resulting metabolic acidosis. It should always be expressed as a percentage of the maximum oxygen consumption (VO 2 max) [4]. The AT occurs at about 50-60% of VO 2 max in normal individuals but has a range of 30-80%.…”

Section: Editorialmentioning

confidence: 99%

“…In such a situation, rationing of resources will be mandatory and triage will be inevitable. Suggestions for such triage guidelines have been proposed [4] and many have adopted these locally; but they are yet to be ratified or alternatives provided at a national level. Many will have little appetite for such a process of ratification, but the pandemic is here and it is essential that the clinicians who may need to make these decisions are not doing so in isolation and without guidance.…”

mentioning

confidence: 99%

Critical care bed capacity during the flu pandemic: implications for anaesthetic and critical care departments

Handy

2009

Anaesthesia

View full text Add to dashboard Cite

A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

Grissom¹,

Brown²,

Kuttler³

et al. 2010

Disaster med. public health prep.

143

133

View full text Add to dashboard Cite

ABSTRACTObjective: The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score.Methods: After a retrospective derivation in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during the 2008 calendar year and compared the ability to predict mortality and the need for mechanical ventilation.Results: A total of 1770 patients (56% male patients) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% confidence interval 0.81-.85) and 0.84 (95% confidence interval 0.82-.85), respectively (P = .33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the intensive care unit with an AUC of 0.78 and 0.79, respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted the need for mechanical ventilation on day 3, with an AUC of 0.83 and 0.82, respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58%, respectively.Conclusions: The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.(Disaster Med Public Health Preparedness. 2010;4:277-284)

show abstract

Development of a triage protocol for critical care during an influenza pandemic

Cited by 335 publications

References 37 publications

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

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

Critical care bed capacity during the flu pandemic: implications for anaesthetic and critical care departments

A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

Contact Info

Product

Resources

About