Evaluation of score-based tertiary triage policies during the COVID-19 pandemic: simulation study with real-world intensive care data

  • Objective The explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the “best for the most” patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of a tertiary triage of patients arises. Methods We provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in a COVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPS II), areObjective The explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the “best for the most” patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of a tertiary triage of patients arises. Methods We provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in a COVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPS II), are compared based on the resulting mortality in the ICU and inferential statistics. Results Our study shows that score-based tertiary triage policies outperform non-score-based tertiary triage policies including compliance with the German Triage Act. Based on our simulation model, a SAPS II score-based tertiary triage policy reduces mortality in the ICU by up to 18 percentage points. The longer the queue of critical care patients waiting for ICU treatment and the larger the maximum number of patients subject to tertiary triage, the greater the effect on the reduction of mortality in the ICU. Conclusion A SAPS II score-based tertiary triage policy was superior in our simulation model. Random allocation or “first come, first served” policies yield the lowest survival rates, as will adherence to the new German Triage Act. An interdisciplinary discussion including an ethical and legal perspective is important for the social interpretation of our data-driven results.show moreshow less

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Metadaten
Author:Christina C. Bartenschlager, Jens O. Brunner, Michael KubicielORCiDGND, Axel R. HellerORCiDGND
URN:urn:nbn:de:bvb:384-opus4-1150463
Frontdoor URLhttps://opus.bibliothek.uni-augsburg.de/opus4/115046
ISSN:2193-6218OPAC
ISSN:2193-6226OPAC
Parent Title (German):Medizinische Klinik: Intensivmedizin und Notfallmedizin
Title Additional (German):Beurteilung von scorebasierten Strategien tertiärer Triage während der COVID-19-Pandemie: Simulationsstudie mit realen Daten aus der Intensivpflege
Publisher:Springer Science and Business Media LLC
Type:Article
Language:English
Year of first Publication:2025
Publishing Institution:Universität Augsburg
Release Date:2024/08/28
Volume:120
First Page:307
Last Page:315
DOI:https://doi.org/10.1007/s00063-024-01162-8
Institutes:Juristische Fakultät
Wirtschaftswissenschaftliche Fakultät
Wirtschaftswissenschaftliche Fakultät / Institut für Betriebswirtschaftslehre
Juristische Fakultät / Institut für die gesamten Strafrechtswissenschaften
Medizinische Fakultät
Wirtschaftswissenschaftliche Fakultät / Institut für Betriebswirtschaftslehre / Lehrstuhl für Health Care Operations / Health Information Management
Juristische Fakultät / Institut für die gesamten Strafrechtswissenschaften / Lehrstuhl für Deutsches, Europäisches und Internationales Straf- und Strafprozessrecht, Medizin- und Wirtschaftsstrafrecht
Medizinische Fakultät / Universitätsklinikum
Medizinische Fakultät / Lehrstuhl für Anästhesiologie und Operative Intensivmedizin
Nachhaltigkeitsziele
Nachhaltigkeitsziele / Ziel 3 - Gesundheit und Wohlergehen
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):CC-BY 4.0: Creative Commons: Namensnennung (mit Print on Demand)