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Comparative Study
. 2020 Dec 1;3(12):e2029250.
doi: 10.1001/jamanetworkopen.2020.29250.

Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators

Hannah Wunsch  1   2   3   4   5   6 , Andrea D Hill  1   2 , Nicholas Bosch  7 , Neill K J Adhikari  1   2   4   8 , Gordon Rubenfeld  1   2   4   8 , Allan Walkey  7 , Bruno L Ferreyro  4   9 , Bourke W Tillmann  1   4 , Andre C K B Amaral  1   2   4   8 , Damon C Scales  1   2   3   4   8   10 , Eddy Fan  4   8   9 , Brian H Cuthbertson  1   2   4   5 , Robert A Fowler  1   2   3   4   8
Affiliations
Comparative Study

Comparison of 2 Triage Scoring Guidelines for Allocation of Mechanical Ventilators

Hannah Wunsch et al. JAMA Netw Open. .

Erratum in

  • Clarification of Triage Scoring Criteria.
    [No authors listed] [No authors listed] JAMA Netw Open. 2021 Feb 1;4(2):e212183. doi: 10.1001/jamanetworkopen.2021.2183. JAMA Netw Open. 2021. PMID: 33555333 Free PMC article. No abstract available.

Abstract

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Walkey reported receiving royalties from a patent with UpToDate. Dr Scales reported receiving grants from the Canadian Institutes for Health Research outside the submitted work. Dr Fan reported receiving personal fees from ALung Technologies Inc, MC3 Cardiopulmonary, Fresenius Medical Care, and Getinge outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Number of Patients Meeting Each Ventilator Allocation Triage Level During the First 24 Hours of Admission to an Intensive Care Unit for the New York State and White and Lo Guidelines and for the New York State Guidelines 48 and 120 Hours After Admission
See this image and copyright information in PMC

Comment in

References

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