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Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States

Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechani...

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Autores principales: Jezmir, Julia L., Bharadwaj, Maheetha, Chaitoff, Alexander, Diephuis, Bradford, Crowley, Conor P., Kishore, Sandeep P., Goralnick, Eric, Merriam, Louis T., Milliken, Aimee, Rhee, Chanu, Sadovnikoff, Nicholas, Shah, Sejal B., Gupta, Shruti, Leaf, David E., Feldman, William B., Kim, Edy Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316067/
https://www.ncbi.nlm.nih.gov/pubmed/34337554
http://dx.doi.org/10.1016/j.xcrm.2021.100376
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author Jezmir, Julia L.
Bharadwaj, Maheetha
Chaitoff, Alexander
Diephuis, Bradford
Crowley, Conor P.
Kishore, Sandeep P.
Goralnick, Eric
Merriam, Louis T.
Milliken, Aimee
Rhee, Chanu
Sadovnikoff, Nicholas
Shah, Sejal B.
Gupta, Shruti
Leaf, David E.
Feldman, William B.
Kim, Edy Y.
author_facet Jezmir, Julia L.
Bharadwaj, Maheetha
Chaitoff, Alexander
Diephuis, Bradford
Crowley, Conor P.
Kishore, Sandeep P.
Goralnick, Eric
Merriam, Louis T.
Milliken, Aimee
Rhee, Chanu
Sadovnikoff, Nicholas
Shah, Sejal B.
Gupta, Shruti
Leaf, David E.
Feldman, William B.
Kim, Edy Y.
author_sort Jezmir, Julia L.
collection PubMed
description Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.
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spelling pubmed-83160672021-07-28 Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States Jezmir, Julia L. Bharadwaj, Maheetha Chaitoff, Alexander Diephuis, Bradford Crowley, Conor P. Kishore, Sandeep P. Goralnick, Eric Merriam, Louis T. Milliken, Aimee Rhee, Chanu Sadovnikoff, Nicholas Shah, Sejal B. Gupta, Shruti Leaf, David E. Feldman, William B. Kim, Edy Y. Cell Rep Med Report Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities. Elsevier 2021-07-28 /pmc/articles/PMC8316067/ /pubmed/34337554 http://dx.doi.org/10.1016/j.xcrm.2021.100376 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Report
Jezmir, Julia L.
Bharadwaj, Maheetha
Chaitoff, Alexander
Diephuis, Bradford
Crowley, Conor P.
Kishore, Sandeep P.
Goralnick, Eric
Merriam, Louis T.
Milliken, Aimee
Rhee, Chanu
Sadovnikoff, Nicholas
Shah, Sejal B.
Gupta, Shruti
Leaf, David E.
Feldman, William B.
Kim, Edy Y.
Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
title Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
title_full Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
title_fullStr Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
title_full_unstemmed Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
title_short Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
title_sort performance of crisis standards of care guidelines in a cohort of critically ill covid-19 patients in the united states
topic Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316067/
https://www.ncbi.nlm.nih.gov/pubmed/34337554
http://dx.doi.org/10.1016/j.xcrm.2021.100376
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