Abstract
Background: At the start of the coronavirus disease 2019 (COVID-19) pandemic there was widespread concern about potentially overwhelming demand for intensive care and the need for intensive care unit (ICU) triage. In March 2020, a draft United Kingdom (UK) guideline proposed a decision-support tool (DST). We sought to evaluate the accuracy of the tool in patients with COVID-19. Methods: We retrospectively identified patients in two groups: referred and not referred to intensive care in a single UK national health service (NHS) trust in April 2020. Age, Clinical Frailty Scale score (CFS), and co-morbidities were collected from patients’ records and recorded, along with ceilings of treatment and outcome. We compared the DST, CFS, and age alone as predictors of mortality, and treatment ceiling decisions. Results: In total, 151 patients were included in the analysis, with 75 in the ICU and 76 in the non-ICU-reviewed groups. Age, clinical frailty and DST score were each associated with increased mortality and higher likelihood of treatment limitation (p-values all <.001). A DST cut-off score of >8 had 65% (95% confidence interval (CI) 51%-79%) sensitivity and 63% (95% CI 54%-72%) specificity for predicting mortality. It had a sensitivity of 80% (70%-88%) and specificity of 96% (95% CI 90%-100%) for predicting treatment limitation. The DST was more discriminative than age alone (p<0.001), and potentially more discriminative than CFS (p=0.08) for predicting treatment ceiling decisions. Conclusions: During the first wave of the COVID-19 pandemic, in a hospital without severe resource limitations, a hypothetical decision support tool was limited in its predictive value for mortality, but appeared to be sensitive and specific for predicting treatment limitation.
Highlights
In the first phase of the coronavirus disease 2019 (COVID-19) pandemic, in March 2020, there was widespread concern in the United Kingdom (UK) that there would be insufficient intensive care unit (ICU) beds and mechanical ventilators to treat the number of patients presenting with severe COVID-191,2
The aim of this study was to evaluate the proposed Moral and Ethical Advisory Group (MEAG) decision-support tool (DST) and Clinical Frailty Scale score (CFS) threshold for predicting mortality and for identifying patients judged clinically appropriate for intensive care admission, in patients hospitalised with COVID-19 in a hospital without severe resource limitations during the first wave of the pandemic
We retrospectively identified a control group of patients with COVID-19 admitted to Oxford University Hospitals NHS Foundation Trust (OUH) but not referred to intensive care. (Decisions about treatment for this cohort were made by the treating consultant/senior registrar on the basis of the patient’s wishes and clinical appropriateness)
Summary
In the first phase of the coronavirus disease 2019 (COVID-19) pandemic, in March 2020, there was widespread concern in the United Kingdom (UK) that there would be insufficient intensive care unit (ICU) beds and mechanical ventilators to treat the number of patients presenting with severe COVID-191,2. A draft UK national pandemic allocation guideline, developed by the UK Moral and Ethical Advisory Group (MEAG) in conjunction with the Intensive Care Society in late March 2020, proposed a scoring system incorporating age, frailty and co-morbidities (Figure 1)[9,10]. This suggested benefit of intubation and ventilation for patients with a Decision Support Tool (DST) score of eight or below, while for patients with a DST of >8 it would be appropriate to limit treatment (potentially including continuous positive airway pressure (CPAP)/non-invasive ventilation). Conclusions: During the first wave of the COVID-19 pandemic, in a hospital without severe resource limitations, a hypothetical decision support tool was limited in its predictive value for mortality, but article can be found at the end of the article
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
