Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds*

Gall, Christine M.; Wetzel, Randall C.; Kolker, Alexander; Kanter, Robert K.; Toltzis, Philip

doi:10.1097/ccm.0000000000001759

Cited by 13 publications

(6 citation statements)

References 11 publications

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“…The development of instruments to allocate scarce resources increases in periods of pandemics, as occurred with influenza [17][18][19][20][21][22][23][24], with severe respiratory distress syndrome (SARS) [18,23] and nowadays with COVID-19 [25][26][27].…”

Section: Instrumentsmentioning

confidence: 99%

“…After the SARS outbreak in 2003 [28], a pioneering guideline for triage in intensive care in pandemics [29] was developed and published, and this became a reference for the development of new instruments [17][18][19][20][21][22][23][24][25][26][27][30][31][32]]. An additional file shows a summary of each instrument identified in this investigation in more detail (see Additional file 2).…”

Section: Instrumentsmentioning

confidence: 99%

“…Some of the instruments found in this study [17,[20][21][22][23][24][25][26][27][29][30][31], direct screening for access to intensive care (intensive care beds, hemodynamic and respiratory support, antibiotic therapy, renal replacement therapy), while others [18,19,32] deal specifically with the allocation of invasive mechanical ventilators.…”

Section: Instrumentsmentioning

confidence: 99%

“…In general, the structure of the instruments includes clinical, non-clinical, and tiebreaker criteria, which are permeated by ethical aspects for decision making in the allocation of scarce resources [17][18][19][20][21][22][23][24][25][26][27][29][30][31][32] (Table 2).…”

Section: Instrumentsmentioning

confidence: 99%

“…The inclusion criteria must be objective [18][19][20][21][22][23][24][25][26][27][29][30][31][32] and facilitate the suitable and rapid referral of potential survivors during pandemics or major disasters [53]. Exclusion criteria should identify patients who are unlikely to obtain benefits through intensive care [53], as recommended by the European Society of Intensive Care Medicine task force [23,54].…”

Section: Clinical Criteriamentioning

confidence: 99%

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COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

et al. 2020

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After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.

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Section: Instrumentsmentioning

confidence: 99%

Section: Instrumentsmentioning

confidence: 99%

Section: Instrumentsmentioning

confidence: 99%

Section: Instrumentsmentioning

confidence: 99%

Section: Clinical Criteriamentioning

confidence: 99%

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COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

et al. 2020

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Ethical surgical triage of patients with head and neck cancer during the COVID‐19 pandemic

et al. 2020

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Background: Coronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami Hospital System, COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended.Methods: An Otolaryngologic Triage Committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for nonsurgical options. Patients were tested twice for coronavirus before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible.Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made.Results: Hundreds of surgeries were canceled. Sixty-five cases screened over 3 weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of COVID-19 exposure tempered these discussions. Conclusions: We describe the use of actively managed surgical triage to fairly balance our patient's health with public health concerns.

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Capacity and Patient Flow Problems: Solutions Using Queuing Analytics and Discrete Event Simulation

Kolker

2024

Business Guides on the Go

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Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds*

Abstract: Use of triage thresholds based on probability of death and duration of mechanical ventilation determined from actual critically ill children's data demonstrated superior population survival during a simulated overwhelming pandemic.

Cited by 13 publications

References 11 publications

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

Ethical surgical triage of patients with head and neck cancer during the COVID‐19 pandemic

Capacity and Patient Flow Problems: Solutions Using Queuing Analytics and Discrete Event Simulation

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