Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion

Johnson, Erin; Diekema, Douglas S.; Lewis‐Newby, Mithya; King, Mary A.

doi:10.1017/s1049023x14000909

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…Nevertheless, because the original START system has been well-accepted as a tool for pediatric and adult evacuees, the green category may be immediately perceived as "low-risk evacuees." 17 This is especially important because multiple professionals with both medical and nonmedical backgrounds need to share patients' information before a NICU evacuation plan is developed. 5,18 Finally, START-Neo-R has the possible negative effect of automatically determining categories based on a few keywords.…”

Section: Discussionmentioning

confidence: 99%

A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities

Imai

Suzuki

Fukaya

et al. 2022

Prehosp. Disaster med.

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Introduction: Hospitalized neonates are vulnerable to natural and man-made disasters because of their persistent requirement for medical resources and may need to be evacuated to safe locations when electricity and medical gas supply become unreliable. In Japan, a triage system for hospitalized neonates, or the Simple Triage and Rapid Treatment for Neonates, Revised (START-Neo-R), has been used to determine whether neonates are in suitable conditions for transportation. However, this scale is not useful to determine the evacuation order of neonates because a considerable number of evacuees are classified into the same categories. Study Objective: To solve this problem, a novel triage system, Neonatal Extrication Triage (NEXT) was developed. This study tested the validity and reproducibility of both triages and compared them with a standardized prognostic scoring system for hospitalized neonates, the Neonatal Therapeutic Intervention Scoring System (NTISS). Methods: In this retrospective observational study, physicians and nurses independently assessed each neonate hospitalized at a tertiary neonatal intensive care unit (NICU) twice weekly using NEXT and START-Neo-R. The NEXT system comprises six questionnaires regarding medical resources required during transition and transportation, providing composite scores on a 12-point scale. The START-Neo-R classified neonates into five levels based on the severity of disease and dependence on medical care. Inter-rater reliability of both systems was assessed using Cohen’s kappa coefficient, whereas the criterion validity with NTISS was assessed using Spearman’s correlation coefficient. Results: Overall, 162 neonates were assessed for 49 days, resulting in triage data for 1,079 accumulated patients. Both NEXT scores and START-Neo-R ranks were well-dispersed across different levels without excessive accumulation in specific categories. Inter-rater reliability of NEXT (kappa coefficient, 0.973; 95% confidence interval, 0.969-0.976) and START-Neo-R (kappa coefficient, 0.952; 95% confidence interval, 0.946-0.957) between physicians and nurses was sufficiently high. The correlation coefficient of NEXT and START-Neo-R scores with NTISS scores were 0.889 (P <.001) and 0.850 (P <.001), respectively. Conclusions: Both START-Neo-R and NEXT had good reproducibility and correlation with the severity of neonates indicated by NTISS. With its well-dispersed scores across different levels, the NEXT system might be a powerful tool to determine the priority of evacuation objectively.

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Section: Discussionmentioning

confidence: 99%

A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities

Imai

Suzuki

Fukaya

et al. 2022

Prehosp. Disaster med.

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“…There is thus a need for an ethically sound, widely accepted, and well-validated approach for allocation of scarce resources for children during a disaster (1,4,6). Although pediatric providers are divided on the use of protocols for triage decisions (7), both the PEMCC Task Force and CHEST guidelines recommend that objective protocols rather than ad hoc clinical judgment be used to determine allocation of limited resources during crises (1,8). Several pediatric illness severity scores have been evaluated for ventilator-triage protocols; however, only the Pediatric Logistic Organ Dysfunction (PELOD) score (9) fulfills all criteria deemed important for use in a triage algorithm (10).…”

mentioning

confidence: 99%

Prediction of Pediatric Critical Care Resource Utilization for Disaster Triage*

Killien

Mills

Errett

et al. 2020

Pediatric Critical Care Medicine

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Objectives: Pediatric protocols to guide allocation of limited resources during a disaster lack data to validate their use. The 2011 Pediatric Emergency Mass Critical Care Task Force recommended that expected duration of critical care be incorporated into resource allocation algorithms. We aimed to determine whether currently available pediatric illness severity scores can predict duration of critical care resource use. Design: Retrospective cohort study. Setting: Seattle Children's Hospital. Patients: PICU patients admitted 2016-2018 for greater than or equal to 12 hours (n = 3,206). Interventions: None. Measurements and Main Results: We developed logistic and linear regression models in two-thirds of the cohort to predict need for and duration of PICU resources based on Pediatric Risk of Mortality-III, Pediatric Index of Mortality-3, and serial Pediatric Logistic Organ Dysfunction-2 scores. We tested the predictive accuracy of the models with the highest area under the receiver operating characteristic curve (need for each resource) and R 2 (duration of use) in a validation cohort of the remaining one of three of the sample and among patients admitted during one-third of the sample and among patients admitted during surges of respiratory illness. Pediatric Logistic Organ Dysfunction score calculated 12 hours postadmission had higher predictive accuracy than either Pediatric Risk of Mortality or Pediatric Index of Mortality scores. Models incorporating 12-hour Pediatric Logistic Organ Dysfunction score, age, Pediatric Overall Performance Category, Pediatric Cerebral Performance Category, chronic mechanical ventilation, and postoperative status had an area under the receiver operating characteristic curve = 0.8831 for need for any PICU resource (positive predictive value 80.2%, negative predictive value 85.9%) and area under the receiver operating characteristic curve = 0.9157 for mechanical ventilation (positive predictive value 85.7%, negative predictive value 89.2%) within 7 days of admission. Models accurately predicted greater than or equal to 24 hours of any resource use for 78.9% of patients and greater than or equal to 24 hours of ventilation for 83.1%. Model fit and accuracy improved for prediction of resource use within 3 days of admission, and was lower for noninvasive positive pressure ventilation, vasoactive infusions, continuous renal replacement therapy, extracorporeal membrane oxygenation, and length of stay. Conclusions: A model incorporating 12-hour Pediatric Logistic Organ Dysfunction score performed well in estimating how long patients may require PICU resources, especially mechanical ventilation. A pediatric disaster triage algorithm that includes both likelihood for survival and for requiring critical care resources could minimize subjectivity in resource allocation decision-making.

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Pediatric Preparedness: Children’s Hospitals Preparation for Disasters

Grove

2017

Curr Treat Options Peds

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Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion

Cited by 6 publications

References 14 publications

A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities

A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities

Prediction of Pediatric Critical Care Resource Utilization for Disaster Triage*

Pediatric Preparedness: Children’s Hospitals Preparation for Disasters

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