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2008 Triage Decision for Society of Critical Care Medicine Triage Priority 3 Patients and Their Outcomes

Dr SHUM Hoi Ping, Pamela Youde Nethersole Eastern Hospital, Hong Kong, November 2008
 
 
 

Objective: To identify factors associated with the triage decision for Society of Critical Care Medicine (SCCM) triage priority 3 patients (critically ill but have a reduced likelihood of recovery because of underlying disease or nature of their acute illness), and their outcomes.

 

Design: A single-centre, prospective observational cohort study.

 

Setting: General medical-surgical intensive care unit (ICU) in a tertiary regional hospital.

 

Interventions: None

 

Measurements and main results:  The study period lasted 9 months from Jan 2007 to Sept 2007 and all patients were followed up for at least half a year.  Of the 1346 triaged patients, 250 belonging to SCCM priority 3 were included for analysis.  30.4% (76/250) were admitted and 69.6% (174/250) rejected.  Medical cases were more likely to be rejected than surgical cases or neuro-surgical cases (p<0.001).  Diagnostic category differed significantly between those admitted and those rejected (p<0.001).  Those with poorer physician-predicted chance of long-term survival (>50% chance of death within 1 month) were more likely to be rejected (53.4% vs. 9.2%, p<0.001) than those with a better predicted prognosis (no fatal disease).  The MPMII0-predicted mortality was higher for those rejected from ICU care than those admitted (47.6% vs. 32.4%, p<0.001).  In multiple logistic regression analysis, the following factors were independently correlated with denial from ICU admission: non-post-operative status (OR 26.2, 95% CI 7.6-90.9, p<0.001), and those predicted to have more than 50% chance of death in the coming 1-month (OR 11.8, 95% CI 4.6-30.5, p<0.001).  Cox regression analysis showed that the following were independently correlated with higher medium-term mortality: rejection from ICU care (HR 2.8, CI 1.88-4.15, p<0.001), higher MPMII0-predicted mortality (HR 1.12 for every 10% increment, CI 1.06-1.19, p<0.001), and presence of renal disease as admission diagnosis (HR 2.28, CI 1.23-4.24, p=0.009).

 

Conclusion:  For SCCM triage priority 3 patients, non-post-operative status and physician-predicted chance of poor long-term survival correlated with the triage decision to reject.  Patient had lower medium-term survival if they were denied from ICU admission, had higher MPMII0-predicted patient mortality or had renal disease as the admission diagnosis. 

 

Keywords:

SCCM triage priority 3 patients, Intensive care, triage decision, survival

 

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