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Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators

IMPORTANCE: In the current setting of the coronavirus disease 2019 pandemic, there is concern for the possible need for triage criteria for ventilator allocation; to our knowledge, the implications of using specific criteria have never been assessed. OBJECTIVE: To determine which and how many admiss...

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Autores principales: Wunsch, Hannah, Hill, Andrea D., Bosch, Nicholas, Adhikari, Neill K. J., Rubenfeld, Gordon, Walkey, Allan, Ferreyro, Bruno L., Tillmann, Bourke W., Amaral, Andre C. K. B., Scales, Damon C., Fan, Eddy, Cuthbertson, Brian H., Fowler, Robert A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737087/
https://www.ncbi.nlm.nih.gov/pubmed/33315112
http://dx.doi.org/10.1001/jamanetworkopen.2020.29250
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author Wunsch, Hannah
Hill, Andrea D.
Bosch, Nicholas
Adhikari, Neill K. J.
Rubenfeld, Gordon
Walkey, Allan
Ferreyro, Bruno L.
Tillmann, Bourke W.
Amaral, Andre C. K. B.
Scales, Damon C.
Fan, Eddy
Cuthbertson, Brian H.
Fowler, Robert A.
author_facet Wunsch, Hannah
Hill, Andrea D.
Bosch, Nicholas
Adhikari, Neill K. J.
Rubenfeld, Gordon
Walkey, Allan
Ferreyro, Bruno L.
Tillmann, Bourke W.
Amaral, Andre C. K. B.
Scales, Damon C.
Fan, Eddy
Cuthbertson, Brian H.
Fowler, Robert A.
author_sort Wunsch, Hannah
collection PubMed
description IMPORTANCE: In the current setting of the coronavirus disease 2019 pandemic, there is concern for the possible need for triage criteria for ventilator allocation; to our knowledge, the implications of using specific criteria have never been assessed. OBJECTIVE: To determine which and how many admissions to intensive care units are identified as having the lowest priority for ventilator allocation using 2 distinct sets of proposed triage criteria. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted in spring 2020 used data collected from US hospitals and reported in the Philips eICU Collaborative Research Database. Adult admissions (N = 40 439) to 291 intensive care units from 2014 to 2015 who received mechanical ventilation and were not elective surgery patients were included. EXPOSURES: New York State triage criteria and original triage criteria proposed by White and Lo. MAIN OUTCOMES AND MEASURES: Sequential Organ Failure Assessment (SOFA) scores were calculated for admissions. The proportion of patients who met initial criteria for the lowest level of priority for mechanical ventilation using each set of criteria and their characteristics and outcomes were assessed. Agreement was compared between the 2 sets of triage criteria, recognizing differences in stated criteria aims. RESULTS: Among 40 439 intensive care unit admissions of patients who received mechanical ventilation, the mean (SD) age was 62.6 (16.6) years, 54.9% were male, and the mean (SD) SOFA score was 4.5 (3.7). Using the New York State triage criteria, 8.9% (95% CI, 8.7%-9.2%) were in the lowest priority category; these lowest priority admissions had a mean (SD) age of 62.9 (16.6) years, used a median (interquartile range) of 57.3 (20.1-133.5) ventilator hours each, and had a hospital survival rate of 38.6% (95% CI, 37.0%-40.2%). Using the White and Lo triage criteria, 4.3% (95% CI, 4.1%-4.5%) were in the lowest priority category; these admissions had a mean (SD) age of 68.6 (13.2) years, used a median (interquartile range) of 61.7 (24.3-142.8) ventilator hours each, and had a hospital survival rate of 56.2% (95% CI, 53.8%-58.7%). Only 655 admissions (1.6%) were in the lowest priority category for both guidelines, with the κ statistic for agreement equal to 0.20 (95% CI, 0.18-0.21). CONCLUSIONS AND RELEVANCE: Use of 2 initially proposed ventilator triage guidelines identified approximately 1 in every 10 to 25 admissions as having the lowest priority for ventilator allocation, with little agreement. Clinical assessment of different potential criteria for triage decisions in critically ill populations is important to ensure valid and equitable allocation of resources.
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spelling pubmed-77370872020-12-17 Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators Wunsch, Hannah Hill, Andrea D. Bosch, Nicholas Adhikari, Neill K. J. Rubenfeld, Gordon Walkey, Allan Ferreyro, Bruno L. Tillmann, Bourke W. Amaral, Andre C. K. B. Scales, Damon C. Fan, Eddy Cuthbertson, Brian H. Fowler, Robert A. JAMA Netw Open Original Investigation IMPORTANCE: In the current setting of the coronavirus disease 2019 pandemic, there is concern for the possible need for triage criteria for ventilator allocation; to our knowledge, the implications of using specific criteria have never been assessed. OBJECTIVE: To determine which and how many admissions to intensive care units are identified as having the lowest priority for ventilator allocation using 2 distinct sets of proposed triage criteria. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted in spring 2020 used data collected from US hospitals and reported in the Philips eICU Collaborative Research Database. Adult admissions (N = 40 439) to 291 intensive care units from 2014 to 2015 who received mechanical ventilation and were not elective surgery patients were included. EXPOSURES: New York State triage criteria and original triage criteria proposed by White and Lo. MAIN OUTCOMES AND MEASURES: Sequential Organ Failure Assessment (SOFA) scores were calculated for admissions. The proportion of patients who met initial criteria for the lowest level of priority for mechanical ventilation using each set of criteria and their characteristics and outcomes were assessed. Agreement was compared between the 2 sets of triage criteria, recognizing differences in stated criteria aims. RESULTS: Among 40 439 intensive care unit admissions of patients who received mechanical ventilation, the mean (SD) age was 62.6 (16.6) years, 54.9% were male, and the mean (SD) SOFA score was 4.5 (3.7). Using the New York State triage criteria, 8.9% (95% CI, 8.7%-9.2%) were in the lowest priority category; these lowest priority admissions had a mean (SD) age of 62.9 (16.6) years, used a median (interquartile range) of 57.3 (20.1-133.5) ventilator hours each, and had a hospital survival rate of 38.6% (95% CI, 37.0%-40.2%). Using the White and Lo triage criteria, 4.3% (95% CI, 4.1%-4.5%) were in the lowest priority category; these admissions had a mean (SD) age of 68.6 (13.2) years, used a median (interquartile range) of 61.7 (24.3-142.8) ventilator hours each, and had a hospital survival rate of 56.2% (95% CI, 53.8%-58.7%). Only 655 admissions (1.6%) were in the lowest priority category for both guidelines, with the κ statistic for agreement equal to 0.20 (95% CI, 0.18-0.21). CONCLUSIONS AND RELEVANCE: Use of 2 initially proposed ventilator triage guidelines identified approximately 1 in every 10 to 25 admissions as having the lowest priority for ventilator allocation, with little agreement. Clinical assessment of different potential criteria for triage decisions in critically ill populations is important to ensure valid and equitable allocation of resources. American Medical Association 2020-12-14 /pmc/articles/PMC7737087/ /pubmed/33315112 http://dx.doi.org/10.1001/jamanetworkopen.2020.29250 Text en Copyright 2020 Wunsch H et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Wunsch, Hannah
Hill, Andrea D.
Bosch, Nicholas
Adhikari, Neill K. J.
Rubenfeld, Gordon
Walkey, Allan
Ferreyro, Bruno L.
Tillmann, Bourke W.
Amaral, Andre C. K. B.
Scales, Damon C.
Fan, Eddy
Cuthbertson, Brian H.
Fowler, Robert A.
Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators
title Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators
title_full Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators
title_fullStr Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators
title_full_unstemmed Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators
title_short Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators
title_sort comparison of 2 triage scoring guidelines for allocation of mechanical ventilators
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737087/
https://www.ncbi.nlm.nih.gov/pubmed/33315112
http://dx.doi.org/10.1001/jamanetworkopen.2020.29250
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