L Nelson Sanchez-Pinto1,2,3,4,5,6,7, William F Parker4,5, Anoop Mayampurath6, Sabrina Derrington1,3, Kelly N Michelson1,3,7. 1. Department of Pediatrics (Critical Care), Feinberg School of Medicine, Northwestern University, Chicago, IL. 2. Department of Preventive Medicine (Health & Biomedical Informatics), Feinberg School of Medicine, Northwestern University, Chicago, IL. 3. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 4. Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL. 5. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL. 6. Department of Pediatrics, Section of Hematology and Oncology, The University of Chicago, Chicago, IL. 7. Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Abstract
OBJECTIVES: When healthcare systems are overwhelmed, accurate assessments of patients' predicted mortality risks are needed to ensure effective allocation of scarce resources. Organ dysfunction scores can serve this essential role, but their evaluation in this context has been limited so far. In this study, we sought to assess the performance of three organ dysfunction scores in both critically ill adults and children at clinically relevant mortality thresholds and timeframes for resource allocation and compare it with two published prioritization schemas. DESIGN: Retrospective observational cohort study. SETTING: Three large academic medical centers in the United States. PATIENTS: Critically ill adults and children. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We calculated the daily Sequential Organ Failure Assessment score in adults and the Pediatric Logistic Organ Dysfunction 2 score and the Pediatric Sequential Organ Failure Assessment score in children. There were 49,290 (11.6% mortality) and 19,983 children (2.5% mortality) included in the analysis. Both the Sequential Organ Failure Assessment and Pediatric Sequential Organ Failure Assessment scores had adequate discrimination across relevant timeframes and adequate distribution across relevant mortality thresholds. Additionally, we found that the only published state prioritization schema that includes pediatric and adult patients had poor alignment of mortality risks, giving adults a systematic advantage over children. CONCLUSIONS: In the largest analysis of organ dysfunction scores in a general population of critically ill adults and children to date, we found that both the Sequential Organ Failure Assessment and Pediatric Sequential Organ Failure Assessment scores had adequate performance across relevant mortality thresholds and timeframes for resource allocation. Published prioritization schemas that include both pediatric and adult patients may put children at a disadvantage. Furthermore, the distribution of patient and mortality risk in the published schemas may not adequately stratify patients for some high-stakes allocation decisions. This information may be useful to bioethicists, healthcare leaders, and policy makers who are developing resource allocation policies for critically ill patients.
OBJECTIVES: When healthcare systems are overwhelmed, accurate assessments of patients' predicted mortality risks are needed to ensure effective allocation of scarce resources. Organ dysfunction scores can serve this essential role, but their evaluation in this context has been limited so far. In this study, we sought to assess the performance of three organ dysfunction scores in both critically ill adults and children at clinically relevant mortality thresholds and timeframes for resource allocation and compare it with two published prioritization schemas. DESIGN: Retrospective observational cohort study. SETTING: Three large academic medical centers in the United States. PATIENTS: Critically ill adults and children. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We calculated the daily Sequential Organ Failure Assessment score in adults and the Pediatric Logistic Organ Dysfunction 2 score and the Pediatric Sequential Organ Failure Assessment score in children. There were 49,290 (11.6% mortality) and 19,983 children (2.5% mortality) included in the analysis. Both the Sequential Organ Failure Assessment and Pediatric Sequential Organ Failure Assessment scores had adequate discrimination across relevant timeframes and adequate distribution across relevant mortality thresholds. Additionally, we found that the only published state prioritization schema that includes pediatric and adult patients had poor alignment of mortality risks, giving adults a systematic advantage over children. CONCLUSIONS: In the largest analysis of organ dysfunction scores in a general population of critically ill adults and children to date, we found that both the Sequential Organ Failure Assessment and Pediatric Sequential Organ Failure Assessment scores had adequate performance across relevant mortality thresholds and timeframes for resource allocation. Published prioritization schemas that include both pediatric and adult patients may put children at a disadvantage. Furthermore, the distribution of patient and mortality risk in the published schemas may not adequately stratify patients for some high-stakes allocation decisions. This information may be useful to bioethicists, healthcare leaders, and policy makers who are developing resource allocation policies for critically ill patients.
Authors: J L Vincent; R Moreno; J Takala; S Willatts; A De Mendonça; H Bruining; C K Reinhart; P M Suter; L G Thijs Journal: Intensive Care Med Date: 1996-07 Impact factor: 17.440
Authors: E Lee Daugherty Biddison; Howard S Gwon; Monica Schoch-Spana; Alan C Regenberg; Chrissie Juliano; Ruth R Faden; Eric S Toner Journal: Chest Date: 2017-08-09 Impact factor: 9.410
Authors: E Lee Daugherty Biddison; Ruth Faden; Howard S Gwon; Darren P Mareiniss; Alan C Regenberg; Monica Schoch-Spana; Jack Schwartz; Eric S Toner Journal: Chest Date: 2018-10-11 Impact factor: 9.410
Authors: Colin K Grissom; Samuel M Brown; Kathryn G Kuttler; Jonathan P Boltax; Jason Jones; Al R Jephson; James F Orme Journal: Disaster Med Public Health Prep Date: 2010-12 Impact factor: 1.385
Authors: Eamon P Raith; Andrew A Udy; Michael Bailey; Steven McGloughlin; Christopher MacIsaac; Rinaldo Bellomo; David V Pilcher Journal: JAMA Date: 2017-01-17 Impact factor: 56.272
Authors: Michael G Kahn; Tiffany J Callahan; Juliana Barnard; Alan E Bauck; Jeff Brown; Bruce N Davidson; Hossein Estiri; Carsten Goerg; Erin Holve; Steven G Johnson; Siaw-Teng Liaw; Marianne Hamilton-Lopez; Daniella Meeker; Toan C Ong; Patrick Ryan; Ning Shang; Nicole G Weiskopf; Chunhua Weng; Meredith N Zozus; Lisa Schilling Journal: EGEMS (Wash DC) Date: 2016-09-11
Authors: James L Wynn; Anoop Mayampurath; Kyle Carey; Susan Slattery; Bree Andrews; L Nelson Sanchez-Pinto Journal: J Pediatr Date: 2021-05-19 Impact factor: 6.314
Authors: Albert Nadjarian; Jessica LeClair; Taylor F Mahoney; Eric H Awtry; Jasvinder S Bhatia; Lisa B Caruso; Alexis Clay; David Greer; Karan S Hingorani; L F B Horta; Michel Ibrahim; Michael H Ieong; Thea James; Matthew H Kulke; Remington Lim; Robert C Lowe; James M Moses; Jaime Murphy; Ala Nozari; Anuj D Patel; Brent Silver; Arthur C Theodore; Ryan Shufei Wang; Ellen Weinstein; Stephen A Wilson; Anna M Cervantes-Arslanian Journal: Crit Care Med Date: 2021-10-01 Impact factor: 9.296