Simple triage scoring system predicting death and the need for critical care resources for use during epidemics

Talmor, Daniel; Jones, Alan E.; Rubinson, Lewis; Howell, Michael D.; Shapiro, Nathan I.

doi:10.1097/01.ccm.0000262385.95721.cc

Cited by 111 publications

(70 citation statements)

References 18 publications

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“…Respiratory rate and shock index (defined as the ratio of heart rate to systolic blood pressure) have been demonstrated to be independent valuable prognostic factors in patients with suspected infection (5). On the other hand, it has also been reported that in patients with suspected infection, body temperature and heart rate had no significant prognostic value (5,6). Despite this, the utility of the 4 classic vital signs is clearly underestimated (7).…”

Section: Introductionmentioning

confidence: 86%

“…On the other hand, heart rate was not independently correlated with the SOFA score. Pines et al (6) reported that body temperature and heart rate did not have prognostic value in patients with suspected infection, whereas Talmor et al (5) reported that respiratory rate and shock index were independent factors with prognostic value for patients with suspected infection. The present study showed that decreased blood pressure, increased respiratory rate, and increased shock index were associated with illness severity.…”

Section: Discussionmentioning

confidence: 99%

“…While much attention is given to the fifth vital sign, the utility of the 4 classic signs has been neglected (7). For this reason, for patients evaluated as "not seriously ill" at the emergency department, medical staff tend to skip the measurement of all vital signs (5,8,9). Among the vital signs, blood pressure and respiratory rate are especially ignored, compared to body temperature and heart rate (8, 9).…”

Section: Discussionmentioning

confidence: 99%

“…For instance, a recent prospective observational study reported that initial triage decisions were revised in 7.9% of the patients who consulted emergency departments, after determination of the vital signs (4). Respiratory rate and shock index (defined as the ratio of heart rate to systolic blood pressure) have been demonstrated to be independent valuable prognostic factors in patients with suspected infection (5). On the other hand, it has also been reported that in patients with suspected infection, body temperature and heart rate had no significant prognostic value (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Importance of Vital Signs to the Early Diagnosis and Severity of Sepsis: Association between Vital Signs and Sequential Organ Failure Assessment Score in Patients with Sepsis

et al. 2012

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Objective While much attention is given to the fifth vital sign, the utility of the 4 classic vital signs (blood pressure, respiratory rate, body temperature, and heart rate) has been neglected. The aim of this study was to assess a possible association between vital signs and the Sequential Organ Failure Assessment (SOFA) score in patients with sepsis. Methods We performed a prospective, observational study of 206 patients with sepsis. Blood pressure, respiratory rate, body temperature, and heart rate were measured on arrival at the hospital. The SOFA score was also determined on the day of admission. Results Bivariate correlation analysis showed that all of the vital signs were correlated with the SOFA score. Multiple regression analysis indicated that decreased values of systolic blood pressure (multivariate regression coefficient [Coef] = -0.030, 95% confidence interval [CI] = -0.046 to -0.013) and diastolic blood pressure (Coef = -0.045, 95% CI = -0.070 to -0.019), increased respiratory rate (Coef = 0.176, 95% CI = 0.112 to 0.240), and increased shock index (Coef = 4.232, 95% CI = 2.401 to 6.062) significantly influenced the SOFA score. Conclusion Increased respiratory rate and shock index were significantly correlated with disease severity in patients with sepsis. Evaluation of these signs may therefore improve early identification of severely ill patients at triage, allowing more aggressive and timely interventions to improve the prognosis of these patients.

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Section: Introductionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Importance of Vital Signs to the Early Diagnosis and Severity of Sepsis: Association between Vital Signs and Sequential Organ Failure Assessment Score in Patients with Sepsis

et al. 2012

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“…[7][8][9][10][11][12][13] Next, we searched the Clinical Queries feature of PubMed using parameters for "Clinical prediction guide (narrow)" and "infl uenza." This search yielded 181 articles, of which 5 were possibly relevant, [14][15][16][17][18] but on closer review, all dealt with prognosis of patients with infl uenza rather than diagnosis. Next, we used the "Related articles" feature of PubMed's Clinical Queries service to search for studies indexed using similar key words to a particularly relevant study, that of Stein and colleagues.…”

Section: Methodsmentioning

confidence: 99%

A Systematic Review of Clinical Decision Rules for the Diagnosis of Influenza

Ebell¹,

Afonso²

2011

The Annals of Family Medicine

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PURPOSE In this study, we assessed whether multivariate models and clinical decision rules can be used to reliably diagnose infl uenza. METHODSWe conducted a systematic review of MEDLINE, bibliographies of relevant studies, and previous meta-analyses. We searched the literature for articles evaluating the accuracy of multivariate models, clinical decision rules, or simple heuristics for the diagnosis of infl uenza. Each author independently reviewed and abstracted data from each article; discrepancies were resolved by consensus discussion. Where possible, we calculated sensitivity, specifi city, predictive value, likelihood ratios, and areas under the receiver operating characteristic curve. RESULTSA total of 12 studies met our inclusion criteria. No study prospectively validated a multivariate model or clinical decision rule, and no study performed a split-sample or bootstrap validation of such a model. Simple heuristics such as the so-called fever and cough rule and the fever, cough, and acute onset rule were each evaluated by several studies in populations of adults and children. The areas under the receiver operating characteristic curves were 0.70 and 0.79, respectively. We could not calculate a single summary estimate, however, as the diagnostic threshold varied among studies. CONCLUSIONSThe fever and cough, and the fever, cough, and acute onset heuristics have modest accuracy, but summary estimates could not be calculated. Further research is needed to develop and prospectively validate clinical decision rules to identify patients requiring testing, empiric treatment, or neither. INTRODUCTIONA ccurate diagnosis of infl uenza is important for several reasons. If the probability of disease exceeds the treatment threshold or is below the testing threshold, no further testing is needed. If offi ce-based testing is performed, its interpretation depends on the pretest probability of disease. And, although a systematic review found that neuraminidase inhibitors are of only modest benefi t in patients with undifferentiated infl uenza-like illness, greater benefi t was seen in patients who actually had laboratory-confi rmed infl uenza.1 Accurate diagnosis is also helpful because it enables a more accurate prognosis, implicitly rules out other diagnoses, and guides patient education; however, 2 previous meta-analyses 2,3 showed that individual fi ndings on the history and physical examination have only modest accuracy for the clinical diagnosis of infl uenza (Table 1). These studies did fi nd that certain combinations of variables, such as the combination of fever plus cough, the combination of fever, cough, and acute onset, 3 and the combination of fever plus presentation within 3 days, 2 had positive likelihood ratios for infl uenza between 4.0 and 5.4. These results suggest that clinical decision rules (CDRs) that integrate data from several clinical fi ndings and are developed using multivariate methods might be helpful.Economic analyses have shown that diagnostic testing is cost-effective only when t...

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Coping With Critical Drug Shortages

Rosoff¹,

Patel²,

Scates³

et al. 2012

Arch Intern Med

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The number of critical medication shortages in the United States has reached an unprecedented level, requiring decisions about allocating limited drug supplies. Ad hoc decisions are susceptible to arbitrary judgments, revealing preformed biases for or against groups of people. Health care institutions lack standardized protocols for rationing scarce drugs. We describe the principles on which an ethically justifiable policy of medication allocation during critical shortages was created at our hospital. Based on supportable scientific evidence and with all clinically similar patients treated as similarly deserving of consideration, drugs were distributed according to a hierarchy of clinical need and predicted efficacy. We explain the ethical rationale for the procedures we adopted, how the policy was implemented at a large academic medical center, and more than 1 year of experience with a number of different medications. Our experience has demonstrated the feasibility and utility of formulating a rational and ethically sound policy for scarce resource allocation in an academic teaching hospital that could be used in a variety of health care settings. The method has proven to be reliable, workable, and acceptable to clinicians, staff, and patients.

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Simple triage scoring system predicting death and the need for critical care resources for use during epidemics

Abstract: If, as expected, patient demand far exceeds the capability to provide critical care services in an epidemic, a fair and just system to allocate limited resources will be essential. The triage rule we have developed can serve as an initial guide for such a process.

Cited by 111 publications

References 18 publications

Importance of Vital Signs to the Early Diagnosis and Severity of Sepsis: Association between Vital Signs and Sequential Organ Failure Assessment Score in Patients with Sepsis

Importance of Vital Signs to the Early Diagnosis and Severity of Sepsis: Association between Vital Signs and Sequential Organ Failure Assessment Score in Patients with Sepsis

A Systematic Review of Clinical Decision Rules for the Diagnosis of Influenza

Coping With Critical Drug Shortages

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