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Observational Study
. 2025 Feb 4;25(1):165.
doi: 10.1186/s12879-025-10540-2.

Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study

Julia Minnema #  1   2 , Roos Sablerolles #  3 , Janneke van Kempen  4 , Hugo van der Kuy  3 , Harmke Polinder-Bos  5 , Bob van de Loo  6 , Jorie Versmissen  5   3 , Miriam L Haaksma  7   8 , Melvin Lafeber #  5 , Miriam C Faes #  4 ; COMET research team^
Collaborators, Affiliations
Observational Study

Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study

Julia Minnema et al. BMC Infect Dis. .

Erratum in

Abstract

Objectives: The scarcity of intensive care unit (ICU) beds during the COVID-19 pandemic has led to a large number of national and international guidelines for the triage of ICU admission. Regional variation in medical decision making might affect ICU triage decisions. We investigate whether regional differences in ICU admission, as surrogate for triage decisions, affect in-hospital mortality in COVID-19 patients.

Methods: The COMET study is a multicenter, observational cohort study, including adult patients hospitalized for COVID-19 between March 2020- July 2020. Patients' characteristics, prescribed medication, clinical characteristics, and CFS were collected. Patients from 11 European countries were included and these countries were categorized into two regions: north and south. The effects of region on ICU admission and in-hospital mortality were assessed using logistic regression analyses stratified for frailty.

Results: Frail patients had a higher risk for ICU admission in southern compared to northern countries (OR: 1.64; 95%CI: 1.10-2.46), whereas fit patients had a similar risk for ICU admission in southern compared to northern countries (OR: 0.75; 95%CI: 0.55-1.01). There was no difference in in-hospital mortality between northern and southern countries for fit and frail patients (respectively OR: 0.82; 95% CI 0.52-1.29, and OR: 1.11; 95% CI: 0.74-1.66).

Conclusion: Our study shows that, despite variation in rates of ICU admission between northern and southern countries for frail patients, no difference in in-hospital mortality was observed. This might help optimize prioritization of resources in a pandemic setting while offering options for palliative care instead of ICU admission.

Keywords: COVID-19; Frailty; Policy; Triage.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The institutional review committee of the main site, Erasmus MC in Rotterdam, the Netherlands, approved the study (MEC-2020-0277), and each institutional review board of the participating hospitals approved the use of data, as described in the protocol [8]. Written informed consent was not required, since this study is no subject to the Medical Research Involving Human Subjects Act (WMO) and only limited data was collected which followed routine practice. All data were treated according to the European privacy regulations and the study was performed in accordance with the declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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