Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/26042
Title: Long-term survival of critically ill patients stratified by pandemic triage categories: a retrospective cohort study.
Austin Authors: Darvall, Jai N;Bellomo, Rinaldo ;Bailey, Michael;Anstey, James;Pilcher, David
Affiliation: Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
Data Analytics Research and Evaluation (DARE) Centre
Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Issue Date: Aug-2021
Date: 2021-03-09
Publication information: Chest 2021; 160(2): 538-548
Abstract: The COVID-19 pandemic has led to unprecedented demand for ICU, 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 ICU is unknown, as is the incremental ICU capacity that triage of these patients might create given existing admission practices. What is the short and long-term survival of low vs. high priority patients for ICU admission according to current pandemic triage criteria? and Methods: We analysed prospectively collected registry data (2007-2018) in 23 ICUs in Victoria, Australia, with probabilistic linkage with death registries. After excluding elective surgery, we stratified admissions by 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. We studied 126,687 ICU admissions. After five-years of follow up, 1093/3296 (33%, 95%CI 32%-34%) of "low-priority" patients aged >85 years or with severe chronic illness, and 86/332 (26%, 95%CI 24%-28%) with a SOFA score ≥12 were still alive. 63/290 [22%, 95% CI 17%-27%] of patients in these groups followed 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 than high priority patients (28%). Among non-survivors, low-priority admissions had shorter ICU LOS than medium or high-priority admissions. 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/26042
DOI: 10.1016/j.chest.2021.03.002
Journal: Chest
PubMed URL: 33711333
Type: Journal Article
Subjects: Pandemic
SOFA score
comorbidity
disaster preparedness
intensive care unit
triage
COVID-19
Appears in Collections:Journal articles

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