Predictive Value of Sequential Organ Failure Assessment Score across Patients with and without COVID-19 Infection

Gershengorn, Hayley B.; Patel, Samira; Shukla, Bhavarth; Warde, Prem R.; Soorus, Shane M; Holt, Gregory E.; Kett, Daniel H.; Parekh, Dipen J.; Ferreira, Tanira

doi:10.1513/annalsats.202106-680oc

Cited by 8 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the association between mortality, ICU LOS and the APACHE II score for COVID-19 patients has been observed previously [ 16 , 17 ]. Early maximum SOFA (< 48 h from ICU admission) has been shown to be as discriminant in COVID-19 positive patients than COVID-19 negative patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Automated APACHE II and SOFA score calculation using real-world electronic medical record data in a single center

Mutchmore

Lamontagne

Chassé

et al. 2023

J Clin Monit Comput

View full text Add to dashboard Cite

The integration of illness severity and organ dysfunction scores into clinical practice, including the APACHE II and SOFA scores, has been challenging due to constraints associated to manual score calculation. With electronic medical records (EMR), score calculation automation using data extraction scripts has emerged as a solution. We aimed to demonstrate that APACHE II and SOFA scores calculated with an automated EMR-based data extraction script predict important clinical endpoints. In this retrospective cohort study, every adult patient admitted to one of our three ICUs, between July 1, 2019, and December 31, 2020, were enrolled. For every patient, an automated ICU admission APACHE II score was calculated using EMR data and minimal clinician input. Fully automated daily SOFA scores were calculated for every patient. 4 794 ICU admissions met our selection criteria. Of these ICU admissions, 522 deaths were recorded (10.9% in-hospital mortality rate). The automated APACHE II was discriminant for in-hospital mortality (AU-ROC = 0.83 (95% CI 0.81–0.85)). We observed an association between the APACHE II score and ICU LOS, with a statistically significant mean increase of 1.1 days of ICU LOS (1.1 [1–1.2]; p = < .0001) for each 10 units increase in APACHE score. SOFA score curves did not discrimate significantly between survivors and non-survivors. A partially automated APACHE II score, calculated with real-world EMR data using an extraction script, is associated with in-hospital mortality risk. The automated APACHE II score could potentially constitute an acceptable surrogate of ICU acuity to be used in resource allocation and triaging, especially in time of high demand for ICU beds.

show abstract

Section: Discussionmentioning

confidence: 99%

Automated APACHE II and SOFA score calculation using real-world electronic medical record data in a single center

Mutchmore

Lamontagne

Chassé

et al. 2023

J Clin Monit Comput

View full text Add to dashboard Cite

show abstract

“…Roy et al found that Black patients had higher mean peak and mean 24-hour SOFA scores than patients of other races despite not having significantly greater ICU admission and in-hospital mortality rates. 5 Although Gershengorn and colleagues found SOFA accuracy to be consistent among racial and ethnic groups, 6 accuracy does not guarantee equitable treatment. In a large multisite cohort study, Miller et al found that Black patients' odds of dying were 2% lower than those of White patients with equivalent SOFA scores.…”

Section: Harms Of Using Sofamentioning

confidence: 99%

What Should Be Roles of Federal Clinician Governors in Motivating Equity in Locally Coordinated Triage Protocols?

Mikell

Hoggard

Schmidt

2023

AMA Journal of Ethics

View full text Add to dashboard Cite

This commentary on a case examines racially inequitable outcomes, especially for Black patients, resulting from use of Sequential Organ Failure Assessment (SOFA) scores to triage patients during the COVID-19 pandemic and how inequitable outcomes in triage protocols could be reduced. It also considers the nature and scope of clinician governor responses to members of federally protected classes who are disadvantaged by use of the SOFA score and argues that clinician leaders of the Centers for Disease Control and Prevention, specifically, should provide federal guidance that motivates clear legal accountability.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CaseDr D is an infectious disease specialist, an epidemiologist, and the medical director of a state department of health. Following a flu season that was socially and fiscally devastating, Dr D administers budget for essential personnel, surge planning, tertiary triage strategy, and critical care inventory (eg, ventilators, dialysis machines, medications, personal protective equipment). Dr D assembles a central committee of regional triage officers from around the state, which forges consensus about communication plans that activate the triage strategy across the state in response to an emergency (ie, epidemic, multi-locale mass casualty events, natural disaster) and how to train teams to implement protocols efficiently and equitably.State epidemiological data reveal that low-income communities and communities of color were inequitably burdened (in terms of higher morbidity, more complications, higher mortality) by the most recent flu outbreak. Age-adjusted flu hospitalizations were highest among Black persons, second highest among American Indian and Alaska Native persons, and third highest among Latinx persons.

show abstract

“…These typically require receipt of SARS-CoV-2 therapeutics (eg, dexamethasone or remdesivir) or need for supplemental oxygen in addition to a positive PCR. [3][4][5] Large cohort studies have also used different approaches for defining COVID-19 hospitalizations, including a positive PCR alone, [6][7][8][9] International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes for COVID-19, [10][11][12][13][14][15][16][17][18] institutional definitions, or combinations of these. [19][20][21][22][23][24][25] Notwithstanding the panoply of definitions being used, few data are available that compare estimates of COVID-19 hospitalizations, severity of illness, mortality, and trends between definitions, nor their accuracy in identifying primary or contributing versus incidental infections.…”

mentioning

confidence: 99%

Impact of changing case definitions for coronavirus disease 2019 (COVID-19) hospitalization on pandemic metrics

Shappell

Chan

Chen

et al. 2023

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Objective: To examine the impact of commonly used case definitions for coronavirus disease 2019 (COVID-19) hospitalizations on case counts and outcomes. Design, patients, and setting: Retrospective analysis of all adults hospitalized between March 1, 2020, and March 1, 2022, at 5 Massachusetts acute-care hospitals. Interventions: We applied 6 commonly used definitions of COVID-19 hospitalization: positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) assay within 14 days of admission, PCR plus dexamethasone administration, PCR plus remdesivir, PCR plus hypoxemia, institutional COVID-19 flag, or COVID-19 International Classification of Disease, Tenth Revision (ICD-10) codes. Outcomes included case counts and in-hospital mortality. Overall, 100 PCR-positive cases were reviewed to determine each definition’s accuracy for distinguishing primary or contributing versus incidental COVID-19 hospitalizations. Results: Of 306,387 hospital encounters, 15,436 (5.0%) met the PCR-based definition. COVID-19 hospitalization counts varied substantially between definitions: 4,628 (1.5% of all encounters) for PCR plus dexamethasone, 5,757 (1.9%) for PCR plus remdesivir, 11,801 (3.9%) for PCR plus hypoxemia, 15,673 (5.1%) for institutional flags, and 15,868 (5.2%) for ICD-10 codes. Definitions requiring dexamethasone, hypoxemia, or remdesivir selected sicker patients compared to PCR alone (mortality rates 12.2%, 10.7%, and 8.8% vs 8.3%, respectively). Definitions requiring PCR plus remdesivir or dexamethasone did not detect a reduction in in-hospital mortality associated with the SARS-CoV-2 Omicron variant. ICD-10 codes had the highest sensitivity (98.4%) but low specificity (39.5%) for distinguishing primary or contributing versus incidental COVID-19 hospitalizations. PCR plus dexamethasone had the highest specificity (92.1%) but low sensitivity (35.5%). Conclusions: Commonly used definitions for COVID-19 hospitalizations generate variable case counts and outcomes and differentiate poorly between primary or contributing versus incidental COVID-19 hospitalizations. Surveillance definitions that better capture and delineate COVID-19–associated hospitalizations are needed.

show abstract

Predictive Value of Sequential Organ Failure Assessment Score across Patients with and without COVID-19 Infection

Cited by 8 publications

References 15 publications

Automated APACHE II and SOFA score calculation using real-world electronic medical record data in a single center

Automated APACHE II and SOFA score calculation using real-world electronic medical record data in a single center

What Should Be Roles of Federal Clinician Governors in Motivating Equity in Locally Coordinated Triage Protocols?

Impact of changing case definitions for coronavirus disease 2019 (COVID-19) hospitalization on pandemic metrics

Contact Info

Product

Resources

About