Ethics guidelines on COVID-19 triage—an emerging international consensus

Jöbges, Susanne; Biller‐Andorno, Nikola

doi:10.1186/s13054-020-02927-1

Cited by 117 publications

(110 citation statements)

References 11 publications

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“…Our analysis builds on a much briefer synopsis published previously. 34 In the following, we identify and explore ethically relevant similarities and differences among the guidelines as well as some inconsistencies (see Table 1).…”

Section: Triag E G U Ideline S For the Sar S -Cov-pandemi Cmentioning

confidence: 99%

Recommendations on COVID‐19 triage: international comparison and ethical analysis

et al. 2020

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A pandemic caused by a newly discovered coronavirus (SARS-CoV-2) is raising dilemmas worldwide in relation to health-resource limitations. To address the possible shortage of acute medical-care capacity, national and international medical societies have drawn up guidance for dealing with scarcity. In everyday medical practice, a therapeutic decision to admit a patient to the intensive care unit (ICU), including various stages of care escalation (intubation, circulatory support, dialysis, extra-corporeal membrane oxygenation), requires a medical indication and incorporates the patient's will. Where resources are not limited, this decision is generally made with a focus on the potential benefit to the individual patient, unless the patient opts out of the treatment. If a

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Section: Triag E G U Ideline S For the Sar S -Cov-pandemi Cmentioning

confidence: 99%

Recommendations on COVID‐19 triage: international comparison and ethical analysis

et al. 2020

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“…The possibility that such resources might need to be rationed due to their scarcity creates complex ethical dilemmas [29]. Age and expected chances of functional recovery have been mentioned as possible criteria to be considered if rationing were to become necessary [29]. Our results cannot be translated to critical illness from COVID-19 as the functional outcome of elderly patients surviving ICU hospitalization for complications related to COVID- 19 is not yet well defined.…”

Section: Discussionmentioning

confidence: 88%

“…Managing limited ICU resources has become a remarkable challenge as COVID cases surge throughout the world [27,28]. The possibility that such resources might need to be rationed due to their scarcity creates complex ethical dilemmas [29]. Age and expected chances of functional recovery have been mentioned as possible criteria to be considered if rationing were to become necessary [29].…”

Section: Discussionmentioning

confidence: 99%

Functional outcome after critical illness in older patients: a population-based study

Hajeb

Singh

Sakusic

et al. 2020

Neurological Research

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Purpose: To determine the prevalence of disability among ICU survivors one year after admission, and which factors influence functional outcome. Methods: We examined consecutive patients enrolled in the population-based Mayo Clinic Olmsted Study of Aging and then admitted to medical or surgical adult ICUs at Mayo Clinic, Rochester between January 1, 2006, and December 31, 2014 to determine one-year functional outcomes. Results: 831cases were included. Mean age was 84 years (IQR 79-88). 569 (68.5%) patients were alive one year after ICU admission. Of them, 546 patients had functional assessment at one year and 367 (67.2%) had good functional outcome. On multivariable analysis, poor oneyear functional outcome (death or disability) was more common among women, older patients, and patients with baseline cognitive impairment (mild cognitive impairment or dementia), higher Carlson scores, and longer ICU stay (all P <.01). After excluding deceased patients, these associations remained unchanged. In addition, 120 (32.3%) of 372 patients who had post-ICU cognitive evaluation experienced cognitive decline after the ICU admission. Conclusions: On a population-based cohort of older, predominantly elderly patients, approximately two-thirds of survivors maintained or regained good functional status 1 year after ICU hospitalization. However, older age, female sex, greater comorbidities, abnormal baseline cognition, and longer ICU stay were associated with poor functional recovery and cognitive decline was common.

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“…In some countries, such as the United States[4], the Republic of Korea [5], and Scotland, differing casefatality rates and limited resources have led to the adoption of separate management strategies for severe and nonsevere disease. Particularly in regions with high case volume, the need to conserve the number of available intensive care unit beds and ventilators has dictated home quarantine for patients with nonsevere disease, with reserving hospitalization for patients with severe disease [6][7][8]; however, the patient who suddenly deteriorates while inappropriately quarantined at home will suffer delay in treatment and in turn, worsened prognosis. For patients in quarantine in community, accurate COVID-19 severity self-assessment can guide appropriate and timely medical consultation.…”

Section: Introductionmentioning

confidence: 99%

Progression of Severity in Coronavirus Disease 2019 Patients Before Treatment and a Self-Assessment Scale to Predict Disease Severity

Yao

Tian

Xia

et al. 2020

Preprint

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Background: With the pandemic of Coronavirus Disease 2019, differing case-fatality rates and limited resources have led to adoption of separate management strategies for severe and nonsevere disease. For patients in quarantine in the community, self-assessment of COVID-19 severity risk can guide appropriate medical consultation. Methods: Data from 45,450 patients infected with COVID-19 from January 1 to February 27, 2020 were extracted from the municipal Notifiable Disease Report System in Wuhan, China. T-test and chi-square test were used to investigate the associations of various patient characteristics with disease severity, and multivariable logistic regression models identified strongly correlated variables for inclusion in the scale. Scale accuracy was assessed using receiver operating characteristic analysis. A least absolute shrinkage and selection operator regression cross-validated prediction accuracy.Results: Twelve scale items - age, gender, illness duration, dyspnea, shortness of breath (clinical evidence of altered breathing), hypertension, pulmonary disease, diabetes, cardio/cerebrovascular disease, number of comorbidities, neutrophil percentage, and lymphocyte percentage - were identified and showed good predictive ability (area under the curve =0·72). After excluding the community healthcare laboratory parameters, the remaining model (the final self-assessment scale) showed similar area under the curve (=0·71).Conclusions: Our COVID-19 severity self-assessment scale can be used by patients in the community to predict their risk of developing severe illness and the need for further medical assistance. The tool is also practical for use in preliminary screening in community healthcare settings.

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Ethics guidelines on COVID-19 triage—an emerging international consensus

Cited by 117 publications

References 11 publications

Recommendations on COVID‐19 triage: international comparison and ethical analysis

Recommendations on COVID‐19 triage: international comparison and ethical analysis

Functional outcome after critical illness in older patients: a population-based study

Progression of Severity in Coronavirus Disease 2019 Patients Before Treatment and a Self-Assessment Scale to Predict Disease Severity

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