The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis.
The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis.
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DOI：
10.1186/cc10001
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Cusack R
中科院分区：
文献类型：
--
作者：
Adeniji KA;Cusack R
只有在尽管努力扩大或获得额外能力，但很明显在一个广泛的地理区域将出现资源短缺的情况下，才会启动分流协议。在大流行之前，英国卫生部（DOH）建议使用一个分阶段的分流计划，其中包括安大略卫生部制定的脓毒症相关器官衰竭评估（SOFA），以协助在英国流感爆发期间对重症监护入院和出院人员进行分流。有数据表明，如果在最近的H1N1大流行中使用它，如果激增的能力被压倒，可能会导致治疗的不适当限制。我们回顾性地回顾了简单分诊评分系统（STSS）的性能，作为一个指标的利用医院资源的成年患者确诊H1N1收治的大学教学医院。我们的目的是将其与阶段性初始SOFA评分过程在死亡率、重症监护入院需求和机械通气需求方面进行比较，并评估其有效性。在8个月的时间里，收治了62名确诊的H1N1患者。40例（65%）有记录的合并症，27例（44%）在入院时CXR有肺部变化。19例（31%）患者入住重症监护室，其中5例（26%）患者需要机械通气（MV）。有3人死亡。STSS组分类在预测重症监护资源使用方面表现出更好的区分准确性，ICU入院的受试者工作特征曲线下面积（95%置信区间）为0.88（0.78-0.98），MV需求为0.91（0.83-0.99）。与此相比，分期SOFA评分分别为0.77（0.65-0.89）和0.87（0.72-1.00）。低死亡率限制了生存预测的分析。STSS根据死亡风险对该队列中的患者进行了准确的风险分层，并预测了进入重症监护的可能性和MV的需求。它的单点时间、准确性和易于收集的成分变量使其成为一种替代的可重复系统，以便于在未来任何流感大流行中对患者进行分诊和治疗。
Triage protocols are only initiated when it is apparent that resource deficits will occur across a broad geographical area despite efforts to expand or acquire additional capacity. Prior to the pandemic the UK Department of Health (DOH) recommended the use of a staged triage plan incorporating Sepsis-related Organ Failure Assessment (SOFA) developed by the Ontario Ministry of Health to assist in the triage of critical care admissions and discharges during an influenza outbreak in the UK. There are data to suggest that had it been used in the recent H1N1 pandemic it may have led to inappropriate limitation of therapy if surge capacity had been overwhelmed. We retrospectively reviewed the performance of the Simple Triage Scoring System (STSS) as an indicator of the utilization of hospital resources in adult patients with confirmed H1N1 admitted to a university teaching hospital. Our aim was to compare it against the staged initial SOFA score process with regards to mortality, need for intensive care admission and requirement for mechanical ventilation and assess its validity. Over an 8 month period, 62 patients with confirmed H1N1 were admitted. Forty (65%) had documented comorbidities and 27 (44%) had pneumonic changes on their admission CXR. Nineteen (31%) were admitted to the intensive care unit where 5 (26%) required mechanical ventilation (MV). There were 3 deaths. The STSS group categorization demonstrated a better discriminating accuracy in predicting critical care resource usage with a receiver operating characteristic area under the curve (95% confidence interval) for ICU admission of 0.88 (0.78-0.98) and need for MV of 0.91 (0.83-0.99). This compared to the staged SOFA score of 0.77 (0.65-0.89) and 0.87 (0.72-1.00) respectively. Low mortality rates limited analysis on survival predictions. The STSS accurately risk stratified patients in this cohort according to their risk of death and predicted the likelihood of admission to critical care and the requirement for MV. Its single point in time, accuracy and easily collected component variables commend it as an alternative reproducible system to facilitate the triage and treatment of patients in any future influenza pandemic.
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