CHEST Guidelines-What-Can-Simulations-Tell-Us-About-Triage-Protocol

What-Can-Simulations-Tell-Us-About-Triage-Protocol

Pdf Summary

The COVID-19 pandemic presented unprecedented challenges in the allocation of critical care resources, revealing the inadequacies of existing triage protocols in developed countries. Before the pandemic, triage protocols were based on empiric prognostic models that lacked real-world testing. The onset of COVID-19 forced rapid reassessment of these protocols, highlighting their potential flaws in making clinical decisions and causing distress among healthcare workers.<br /><br />A study by Darvall et al. examined an Australian triage protocol by merging ICU data with death registry data to assess long-term survival prospects of patients in different triage categories. Results showed significant long-term survival even in low-priority categories, questioning the efficacy of the triage method. Criticisms include data loss over follow-up, the use of unrelated comorbidity data, and the exclusion of COVID-19 patients. Despite these limitations, the study's findings suggest that triage protocols may exclude patients who could benefit from intensive care.<br /><br />The study advocates that simulations, while somewhat useful, cannot entirely predict real-world outcomes during pandemics, given their reliance on data not initially meant for triage decisions. For instance, COVID-19 patients often have a lower SOFA score, despite high mortality and disability, challenging the accuracy of resource allocation based on illness severity and historical data.<br /><br />Simulation-based studies might help compare allocation philosophies and identify biases in existing protocols, but they fall short in addressing real-life triage scenarios such as how many beds were freed up by withdrawal of life-sustaining treatments or the survival rates of non-admitted patients. The lack of real-world studies might stem from fear of criticism among healthcare practitioners, emphasizing the need for reporting and transparency in triage practices during pandemics. Until actual data is available, simulations remain a proxy for understanding triage implications during healthcare resource scarcity.

Keywords

COVID-19 pandemic

critical care resources

triage protocols

empiric prognostic models

Darvall study

ICU data

long-term survival

resource allocation

simulation studies

healthcare transparency