Evaluation of Organ Dysfunction Scores for Allocation of Scarce Resources in Critically Ill Children and Adults During a Healthcare Crisis.
Evaluation of Organ Dysfunction Scores for Allocation of Scarce Resources in Critically Ill Children and Adults During a Healthcare Crisis.
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DOI：
10.1097/ccm.0000000000004774
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发表时间：
2021-02-01
影响因子：
8.8
通讯作者：
Michelson KN
中科院分区：
文献类型：
--
作者：
Sanchez-Pinto LN;Parker WF;Mayampurath A;Derrington S;Michelson KN
当医疗系统不堪重负时，需要准确评估患者的预测死亡风险，以确保有效分配稀缺资源。器官功能障碍评分可以发挥这一重要作用，但到目前为止，它们在这方面的评价还很有限。在这项研究中，我们试图评估三个器官功能障碍评分在重症成人和儿童中的临床相关死亡率阈值和资源分配时间范围内的表现，并将其与两个已发表的优先级方案进行比较。在美国三个大型学术医疗中心对危重患者进行的回顾性观察性队列研究。没有。我们计算了成人的每日序贯器官衰竭评估评分（SOFA）和儿童的儿科逻辑器官功能障碍2（PELOD-2）评分和儿科SOFA（pSOFA）评分。分析中包括49，290名成人（死亡率11.6%）和19，983名儿童（死亡率2.5%）。SOFA和pSOFA评分在相关时间范围内具有充分的区分度，并且在相关死亡率阈值内具有充分的分布。此外，我们发现，唯一公布的包括儿童和成人患者的国家优先方案的死亡率风险不一致，使成人比儿童具有系统性优势。在迄今为止对危重成人和儿童一般人群的器官功能障碍评分进行的最大规模分析中，我们发现SOFA和pSOFA评分在相关死亡率阈值和资源分配时间范围内具有足够的性能。已公布的包括儿童和成人患者的优先顺序方案可能会使儿童处于不利地位。此外，在已公布的方案中，患者和死亡风险的分布可能无法充分地对患者进行分层，以做出一些高风险的分配决策。这些信息可能对生物伦理学家，医疗保健领导者和正在为危重患者制定资源分配政策的政策制定者有用。
When healthcare systems are overwhelmed, accurate assessments of patients’ predicted mortality risks are needed to ensure effective allocation of scarce resources. Organ dysfunction scores can serve this essential role, but their evaluation in this context has been limited so far. In this study, we sought to assess the performance of three organ dysfunction scores in both critically ill adults and children at clinically-relevant mortality thresholds and timeframes for resource allocation and compare it to two published prioritization schemas. Retrospective observational cohort study of critically ill patients in three large academic medical centers in the US. None. We calculated the daily Sequential Organ Failure Assessment score (SOFA) in adults and the Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score and the Pediatric SOFA (pSOFA) score in children. There were 49,290 adults (11.6% mortality), and 19,983 children (2.5% mortality) included in the analysis. Both the SOFA and pSOFA scores had adequate discrimination across relevant timeframes and adequate distribution across relevant mortality thresholds. Additionally, we found that the only published state prioritization schema that includes pediatric and adult patients had poor alignment of mortality risks, giving adults a systematic advantage over children. In the largest analysis of organ dysfunction scores in a general population of critically ill adults and children to date, we found that both the SOFA and pSOFA scores had adequate performance across relevant mortality thresholds and timeframes for resource allocation. Published prioritization schemas that include both pediatric and adult patients may put children at a disadvantage. Furthermore, the distribution of patient and mortality risk in the published schemas may not adequately stratify patients for some high-stakes allocation decisions. This information may be useful to bioethicists, healthcare leaders, and policy makers who are developing resource allocation policies for critically ill patients.