TY - JOUR
T1 - Long-term Survival of Critically Ill Patients Stratified According to Pandemic Triage Categories
T2 - A Retrospective Cohort Study
AU - Darvall, Jai N.
AU - Bellomo, Rinaldo
AU - Bailey, Michael
AU - Anstey, James
AU - Pilcher, David
N1 - Funding Information:
Author contributions: J. N. D. is the guarantor of the content of the manuscript, including the data and analysis. J. D. was responsible for study design, literature search, and data interpretation; R. B. and D. P. were responsible for study design, study supervision, data analysis, and data interpretation; M. B. was responsible for study design and data analysis; and J. A. was responsible for data interpretation. All authors contributed to writing and revision of the manuscript, and all authors approved the final version of the manuscript. Financial/nonfinancial disclosures: None declared. Additional information: The e-Figures and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Publisher Copyright:
© 2021 American College of Chest Physicians
PY - 2021/8
Y1 - 2021/8
N2 - Background: The COVID-19 pandemic has led to unprecedented demand for ICUs, with the need to triage admissions along with the development of ICU triage criteria. However, how these criteria relate to outcomes in patients already admitted to the ICU is unknown, as is the incremental ICU capacity that triage of these patients might create given existing admission practices. Research Question: What is the short- and long-term survival of low- vs high-priority patients for ICU admission according to current pandemic triage criteria? Study Design and Methods: This study analyzed prospectively collected registry data (2007-2018) in 23 ICUs in Victoria, Australia, with probabilistic linkage with death registries. After excluding elective surgery, admissions were stratified according to existing ICU triage protocol prioritization as low (age ≥ 85 years, or severe chronic illness, or Sequential Organ Failure Assessment [SOFA] score = 0 or ≥ 12), medium (SOFA score = 8-11) or high (SOFA score = 1-7) priority. The primary outcome was long-term survival. Secondary outcomes were in-hospital mortality, ICU length of stay (LOS) and bed-day usage. Results: This study examined 126,687 ICU admissions. After 5 years of follow-up, 1,093 of 3,296 (33%; 95% CI, 32-34) of “low-priority” patients aged ≥ 85 years or with severe chronic illness and 86 of 332 (26%; 95% CI, 24-28) with a SOFA score ≥ 12 were still alive. Sixty-three of 290 (22%; 95% CI, 17-27) of patients in these groups followed up for 10 years were still alive. Together, low-priority patients accounted for 27% of all ICU bed-days and had lower in-hospital mortality (22%) than the high-priority patients (28%). Among nonsurvivors, low-priority admissions had shorter ICU LOS than medium- or high-priority admissions. Interpretation: Current SOFA score or age or severe comorbidity-based ICU pandemic triage protocols exclude patients with a close to 80% hospital survival, a > 30% five-year survival, and 27% of ICU bed-day use. These findings imply the need for stronger evidence-based ICU triage protocols.
AB - Background: The COVID-19 pandemic has led to unprecedented demand for ICUs, with the need to triage admissions along with the development of ICU triage criteria. However, how these criteria relate to outcomes in patients already admitted to the ICU is unknown, as is the incremental ICU capacity that triage of these patients might create given existing admission practices. Research Question: What is the short- and long-term survival of low- vs high-priority patients for ICU admission according to current pandemic triage criteria? Study Design and Methods: This study analyzed prospectively collected registry data (2007-2018) in 23 ICUs in Victoria, Australia, with probabilistic linkage with death registries. After excluding elective surgery, admissions were stratified according to existing ICU triage protocol prioritization as low (age ≥ 85 years, or severe chronic illness, or Sequential Organ Failure Assessment [SOFA] score = 0 or ≥ 12), medium (SOFA score = 8-11) or high (SOFA score = 1-7) priority. The primary outcome was long-term survival. Secondary outcomes were in-hospital mortality, ICU length of stay (LOS) and bed-day usage. Results: This study examined 126,687 ICU admissions. After 5 years of follow-up, 1,093 of 3,296 (33%; 95% CI, 32-34) of “low-priority” patients aged ≥ 85 years or with severe chronic illness and 86 of 332 (26%; 95% CI, 24-28) with a SOFA score ≥ 12 were still alive. Sixty-three of 290 (22%; 95% CI, 17-27) of patients in these groups followed up for 10 years were still alive. Together, low-priority patients accounted for 27% of all ICU bed-days and had lower in-hospital mortality (22%) than the high-priority patients (28%). Among nonsurvivors, low-priority admissions had shorter ICU LOS than medium- or high-priority admissions. Interpretation: Current SOFA score or age or severe comorbidity-based ICU pandemic triage protocols exclude patients with a close to 80% hospital survival, a > 30% five-year survival, and 27% of ICU bed-day use. These findings imply the need for stronger evidence-based ICU triage protocols.
KW - comorbidity
KW - disaster preparedness
KW - ICU
KW - pandemic
KW - SOFA score
KW - triage
UR - https://www.scopus.com/pages/publications/85109443008
U2 - 10.1016/j.chest.2021.03.002
DO - 10.1016/j.chest.2021.03.002
M3 - Article
C2 - 33711333
AN - SCOPUS:85109443008
SN - 0012-3692
VL - 160
SP - 538
EP - 548
JO - Chest
JF - Chest
IS - 2
ER -