Faculty Collaboration Database

Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States. Cell Rep Med 2021 Sep 21;2(9):100376

Date

08/03/2021

Pubmed ID

34337554

Pubmed Central ID

PMC8316067

DOI

10.1016/j.xcrm.2021.100376

Scopus ID

2-s2.0-85114109454 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.

Author List

Jezmir JL, Bharadwaj M, Chaitoff A, Diephuis B, Crowley CP, Kishore SP, Goralnick E, Merriam LT, Milliken A, Rhee C, Sadovnikoff N, Shah SB, Gupta S, Leaf DE, Feldman WB, Kim EY, STOP-COVID Investigators

Author

Christina Mariyam Joy MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Algorithms
Cohort Studies
Comorbidity
Crew Resource Management, Healthcare
Critical Care
Critical Illness
Female
Hospital Mortality
Humans
Male
Middle Aged
Organ Dysfunction Scores
Pandemics
Practice Guidelines as Topic
Retrospective Studies
Standard of Care
United States