Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center

Albert Nadjarian, MD, MPH; Jessica LeClair, BS; Taylor F. Mahoney, MA; Eric H. Awtry, MD, FACC; Jasvinder S. Bhatia, MD; Lisa B. Caruso, MD, MPH; Alexis Clay, MD; David Greer, MD, MA; Karan S. Hingorani, MD, PhD; L. F. B. Horta, MD; Michel Ibrahim, MD; Michael H. Ieong, MD; Thea James, MD; Matthew H. Kulke, MD; Remington Lim, BA; Robert C. Lowe, MD; James M. Moses, MD; Jaime Murphy, MD; Ala Nozari, MD; Anuj D. Patel, MD; Brent Silver, MD; Arthur C. Theodore, MD; Ryan Shufei Wang, MD; Ellen Weinstein, JD; Stephen A. Wilson, MD, MPH, FAAFP; Anna M. Cervantes-Arslanian, MD

Disclosures

Crit Care Med. 2021;49(10):1739-1748. 

In This Article

Results

A total of 365 patients were identified as having an admission to an ICU during the study period. Elective admissions (such as ICU admitted for isolated postoperative monitoring) were excluded. Of these, 58 patients (16.45%) scored +2 (major) or +4 (severe) for at least one underlying medical condition outlined in the CSC point allocation framework. On average, patients with scored medical conditions were older than the group without (65.53 [14.46] vs 57.17 [17.46] yr; p < 0.01) but had similar sex distribution (46.55% vs 58.96% male; p = 0.08). There were no significant differences in the distribution of race or ICU length of stay between scored and unscored groups. Patients with scored conditions had a trend toward higher in-hospital mortality (13.79% vs 8.14%; p = 0.17) than those without these underlying conditions. Patients with scored conditions had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates (Table 2).

Of the 58 scored patients, eight received points for having ESRD on hemodialysis older than 75 years, seven for cirrhosis, 13 for metastatic cancer, eight for CHF, 19 for CLD, and seven for neurodegenerative conditions. The observed mortality at 1 year among all patients who scored for either +2 (major) or +4 (severe) in aggregate was 46.55% but differed among disease conditions: ESRD on HD (6/8; 75.00%), cirrhosis (3/7; 42.86%), metastatic cancer (8/13; 61.54%), CHF (5/8; 62.50%), CLD (2/19; 10.53%), and neurodegenerative conditions (4/7; 57.14%) (Table 3). When scored patients were subcategorized into +2 (major) and +4 (severe) conditions, all +4 scored categories met the greater than 50% observed mortality at one year except CHF (1/3; 33.33%) and CLD (2/15; 13.33%). For those in the +2 (major) category, all groups had greater than 50% observed mortality at 5 years except cirrhosis (0/1; 0.00%), metastatic cancer (2/6; 33.33%) and CLD (1/3; 33.33%) (Table 4).

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