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Christian, Michael D.; Sprung, Charles L.; King, Mary A.; Dichter, Jeffrey R.; Kissoon, Niranjan; Devereaux, Asha V.; Gomersall, Charles D.

doi:10.1378/chest.14-0736

Cited by 177 publications

(70 citation statements)

References 58 publications

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“…Professional society guidelines 2 and some states' recommendations exclude from access to ICUs large groups of patients with certain comorbid conditions, such as class III or IV heart failure, severe chronic lung disease, end-stage renal disease, and severe cognitive impairment. 2,3 These exclusions are not explicitly justified, and they are ethically flawed because the criteria for exclusion (long-term prognosis and functional status) are selectively applied to only some types of patients, rather than to all patients being considered for critical care. This violates the principle of justice because it applies additional allocation criteria to some patients but not others, without making clear what is ethically different about the patients that would justify doing so.…”

Section: Categorically Excluding Large Groups Of Patients From Receivmentioning

confidence: 99%

A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

White

2020

JAMA

688

677

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Section: Categorically Excluding Large Groups Of Patients From Receivmentioning

confidence: 99%

A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

White

2020

JAMA

688

677

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“…Establishing a triage center, such as in a tented environment or designated area within a facility, could help to make possible that policy. [13,17]…”

Section: A Triage Center Should Be Establishedmentioning

confidence: 99%

Recommendations for Trauma and Emergency General Surgery Practice During COVID-19 Pandemic

Gök

Eryılmaz

Özmen

et al. 2020

Ulus Travma Acil Cerrahi Derg

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COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic.

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“…In most critical incidents the highest level of expertise is deployed for triaging. It is the place where the most experienced and astute direct the fate of individuals 6,14 .…”

Section: Resultsmentioning

confidence: 99%

The performance of national COVID-19 ‘Symptom Checkers’: A comparative case simulation study

Mansab

Bhatti

Goyal

2020

Preprint

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Introduction: The case fatality rate from COVID-19 differs markedly around the world. There are likely a number of factors one can attribute to such disparity, not least of which is differing healthcare models and approaches. Here, we examine the COVID-19 related health advice issued by six different countries, specifically examining the patient-led triage pathways in each country. Methods: A simulation study was conducted on current, nationwide, patient-led triage systems from three countries with low case fatality rates (Singapore, Norway and Japan) and two countries with high case fatality rates (the USA and the UK). Cases were simulated by clinicians to approximate typical COVID-19 presentations (mild, severe and critical), and COVID-19 mimickers (sepsis, bacterial pneumonia). The same simulations were applied to each of the five countrys patient-led triage systems, and the recommendations to refer on for medical care or to advise to stay at home were recorded and compared. Statistical analysis examined the potential correlation between triage outcomes and case fatality rates. Results: Patient-led triage systems from Singapore, Japan and Norway maintained a low threshold for advising clinical contact for patients with possible COVID-19 (88 to 100% of cases were referred). Patient-led triage systems from the USA and the UK maintained high thresholds for advising contact with either call centre support or clinical contact (28 and 33% of cases were referred, respectively), and triaged the majority of cases home with no further healthcare input. There was a strong inverse correlation between percentage of cases referred and the nations case fatality rate (Pearsons Correlation = -0.642, p = 0.01). Conclusion: In this simulation study, the triage algorithms of Singapore, Norway and Japan successfully identified severe COVID-19 and triaged such cases to medical care. The USA triage system and the UKs triage system performed poorly, failing to identify severe COVID-19 infection and sepsis. In this study, the performance of national COVID-19 triage systems strongly correlate with case fatality rates.

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Triage

Cited by 177 publications

References 58 publications

A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

Recommendations for Trauma and Emergency General Surgery Practice During COVID-19 Pandemic

The performance of national COVID-19 ‘Symptom Checkers’: A comparative case simulation study

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