Kirsten M Fiest1,2, Karla D Krewulak1, Kara M Plotnikoff1, Laryssa G Kemp1, Ken Kuljit S Parhar1, Daniel J Niven1,2, John B Kortbeek1,3,4, Henry T Stelfox1,2, Jeanna Parsons Leigh5,6. 1. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada. 2. Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada. 3. Department of Surgery, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada. 4. Department of Anaesthesia, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada. 5. Faculty of Health, School of Health Administration, Dalhousie University, 5850 College Street, Halifax, Nova Scotia, B3H4R2, Canada. J.ParsonsLeigh@dal.ca. 6. Department of Critical Care Medicine, Faculty of Medicine, Dalhousie University, 6299 South St, Halifax, Nova Scotia, B3H4R2, Canada. J.ParsonsLeigh@dal.ca.
Abstract
BACKGROUND: The COVID-19 pandemic has placed sustained demand on health systems globally, and the capacity to provide critical care has been overwhelmed in some jurisdictions. It is unknown which triage criteria for allocation of resources perform best to inform health system decision-making. We sought to summarize and describe existing triage tools and ethical frameworks to aid healthcare decision-making during infectious disease outbreaks. METHODS: We conducted a rapid review of triage criteria and ethical frameworks for the allocation of critical care resources during epidemics and pandemics. We searched Medline, EMBASE, and SCOPUS from inception to November 3, 2020. Full-text screening and data abstraction were conducted independently and in duplicate by three reviewers. Articles were included if they were primary research, an adult critical care setting, and the framework described was related to an infectious disease outbreak. We summarized each triage tool and ethical guidelines or framework including their elements and operating characteristics using descriptive statistics. We assessed the quality of each article with applicable checklists tailored to each study design. RESULTS: From 11,539 unique citations, 697 full-text articles were reviewed and 83 articles were included. Fifty-nine described critical care triage protocols and 25 described ethical frameworks. Of these, four articles described both a protocol and ethical framework. Sixty articles described 52 unique triage criteria (29 algorithm-based, 23 point-based). Few algorithmic- or point-based triage protocols were good predictors of mortality with AUCs ranging from 0.51 (PMEWS) to 0.85 (admitting SOFA > 11). Most published triage protocols included the substantive values of duty to provide care, equity, stewardship and trust, and the procedural value of reason. CONCLUSIONS: This review summarizes available triage protocols and ethical guidelines to provide decision-makers with data to help select and tailor triage tools. Given the uncertainty about how the COVID-19 pandemic will progress and any future pandemics, jurisdictions should prepare by selecting and adapting a triage tool that works best for their circumstances.
BACKGROUND: The COVID-19 pandemic has placed sustained demand on health systems globally, and the capacity to provide critical care has been overwhelmed in some jurisdictions. It is unknown which triage criteria for allocation of resources perform best to inform health system decision-making. We sought to summarize and describe existing triage tools and ethical frameworks to aid healthcare decision-making during infectious disease outbreaks. METHODS: We conducted a rapid review of triage criteria and ethical frameworks for the allocation of critical care resources during epidemics and pandemics. We searched Medline, EMBASE, and SCOPUS from inception to November 3, 2020. Full-text screening and data abstraction were conducted independently and in duplicate by three reviewers. Articles were included if they were primary research, an adult critical care setting, and the framework described was related to an infectious disease outbreak. We summarized each triage tool and ethical guidelines or framework including their elements and operating characteristics using descriptive statistics. We assessed the quality of each article with applicable checklists tailored to each study design. RESULTS: From 11,539 unique citations, 697 full-text articles were reviewed and 83 articles were included. Fifty-nine described critical care triage protocols and 25 described ethical frameworks. Of these, four articles described both a protocol and ethical framework. Sixty articles described 52 unique triage criteria (29 algorithm-based, 23 point-based). Few algorithmic- or point-based triage protocols were good predictors of mortality with AUCs ranging from 0.51 (PMEWS) to 0.85 (admitting SOFA > 11). Most published triage protocols included the substantive values of duty to provide care, equity, stewardship and trust, and the procedural value of reason. CONCLUSIONS: This review summarizes available triage protocols and ethical guidelines to provide decision-makers with data to help select and tailor triage tools. Given the uncertainty about how the COVID-19 pandemic will progress and any future pandemics, jurisdictions should prepare by selecting and adapting a triage tool that works best for their circumstances.
Entities:
Keywords:
COVID-19; Critical care; Intensive care; Medical ethics; Practice guideline; Resource allocation; Triage
Authors: Michael D Christian; Charles L Sprung; Mary A King; Jeffrey R Dichter; Niranjan Kissoon; Asha V Devereaux; Charles D Gomersall Journal: Chest Date: 2014-10 Impact factor: 9.410
Authors: Ryan C Maves; James Downar; Jeffrey R Dichter; John L Hick; Asha Devereaux; James A Geiling; Niranjan Kissoon; Nathaniel Hupert; Alexander S Niven; Mary A King; Lewis L Rubinson; Dan Hanfling; James G Hodge; Mary Faith Marshall; Katherine Fischkoff; Laura E Evans; Mark R Tonelli; Randy S Wax; Gilbert Seda; John S Parrish; Robert D Truog; Charles L Sprung; Michael D Christian Journal: Chest Date: 2020-04-11 Impact factor: 9.410
Authors: B Corbett Walsh; Deepak Pradhan; Vikramjit Mukherjee; Amit Uppal; Mark E Nunnally; Kenneth A Berkowitz Journal: Disaster Med Public Health Prep Date: 2022-06-09 Impact factor: 5.556