Impact of a pandemic triage tool on intensive care admission

Introduction

The issues of pandemic preparedness and the use of critical care resources in a pandemic have been of increased interest recently [1]. We assessed the effect of a proposed pandemic critical care triage tool [2] on admissions to the ICU. The tool aims to identify patients who will most benefit from admission to the ICU and excludes patients considered 'too well', 'too sick', or with comorbidities likely to limit survival in the shorter term.

Methods

To assess the impact of the pandemic tool on our current practice, we performed a retrospective observational study of the application of the pandemic triage tool described by Christian and colleagues [2] to all admissions to our 14-bed general medical–surgical ICU over a 1-month period.

Results

One hundred and nineteen patients were admitted to the ICU. Using the pandemic triage tool, 91 of these patients (76%) did not meet the triage inclusion criteria on admission. As required by the triage tool, patients were reassessed at 48 and 120 hours, with only one of the 91 patients becoming eligible for admission on reassessment. Further assessment of the 29 patients (24%) who met the triage inclusion criteria revealed that 17 of these met the triage exclusion criteria, leaving 12 patients (10%) from the original 119 as qualifying for ICU. One of these 12 was deemed 'too sick' by the triage tool and therefore was also excluded, leaving 11 patients (9%).

Conclusion

Application of this triage tool to our current ICU patient population would radically change practice, and would generate substantial capacity that could be used in the situation of a pandemic. In addition, as the triage tool aims to exclude patients who are less likely to benefit from admission to the ICU, these results also have implications for ICU resource management in the nonpandemic situation.