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Document Type
Rapid Review
Review Code
EOC012001 RR
Question Submitted
January 19, 2021
Date Completed
February 4, 2021
Status
3. Completed
Research Team
EOC
rise, local health authorities are required to triage patients appropriately to maximise resource use
Document Type
Rapid Review
Review Code
EOC012001 RR
Question Submitted
January 19, 2021
Date Completed
February 4, 2021
Status
3. Completed
Research Team
EOC
Key Findings
There is insufficient evidence to recommend a specific clinical prediction tool for COVID-19 patients at this time.
The 4C Mortality tool and associated risk calculator is likely the most validated prediction tool currently available.
Many tools exist and may be applied with caution, as they should be validated in the local context.
There are many patient factors included in different tools when calculating risk of disease severity.
Category
Administration
Clinical Management
Subject
Critical Care
Triage
Priority Level
Level 3 Two weeks (14 days)
Cite As
Vanstone, J; Groot, G; Dalidowicz, M; Fox, L. Are there validated clinical prediction tools of which Covid-19 inpatients are most probable to require ICU level care? 2021 Feb 4; Document no.: EOC012001 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 15 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
CC120301 RR
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
triage protocols tailored for patients with COVID-19. Nevertheless, the protocols must be flexible
Document Type
Rapid Review
Review Code
CC120301 RR
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
Key Findings
No studies directly evaluated the association between level of surge capacity and quality of care indicators for COVID-19 patients. However, in more broad studies, the findings suggest that mortality and other adverse events increase when the strain on the intensive care capacity increases.
A tiered staffing strategy is recommended to meet surge capacity needs in the ICU: High critical care nurse to patient ratios (1:1 or 1:2) are recommended to provide high quality patient care.
There is a lack of high-quality evidence to support ICU triage protocols tailored for patients with COVID-19. Nevertheless, the protocols must be flexible, adaptable according to the availability of local resources, and effective for inter-hospital patient transfer.
While the Crisis Standards of Care (CSC) guidelines (e.g., Saskatchewan’s Critical Care Resource Allocation Framework, published on September 2020) can be used to triage newly admitted COVID-19 patients requiring critical care, there is contradicting evidence about using the Sequential Organ Failure Assessment (SOFA) score for ICU triage of patients with COVID-19.
The literature suggests the use of mathematical modeling to support capacity planning (e.g., very low, low, medium, and high intensity patient surge response)
To relieve pressure from ICUs, other types of units (e.g., Step Down Unit [SDU] or Surge Clinic) can be implemented.
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All adults
Clinical Setting
ICU
Priority Level
Level 1 2-3 days
Cite As
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
CC120401 RR
Question Submitted
December 4, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Critical Care
Review Title: Does data exist on the performance of triage or resource allocation frameworks for COVID
Document Type
Rapid Review
Review Code
CC120401 RR
Question Submitted
December 4, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Critical Care
Key Findings
· There is little literature on the performance of triage frameworks. However, critiques of frameworks can help to inform the development of future protocols. · It is ethically problematic to include age as a triage factor rather than the more nuanced factors of frailty and chronic comorbidities. · The public should be included when creating triage protocols to create transparency and trust in the health system. · Healthcare providers should be familiar with the ethical decisions that have been made in establishing the protocols. However, using a triage team to make decisions about resource allocation would alleviate moral burden from clinicians. · Regular review of current guidelines, such as the use of SOFA scores, is recommended as knowledge about COVID-19 changes. Rapid Review Report: CC120401 RR (Version 1: December 17, 2020 11:45) 2 · Patients should be regularly reassessed to allow for timely redistribution of critical resources.
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All
All adults
Clinical Setting
ICU
Priority Level
Level 3 Two weeks (14 days)
Cite As
Fick, F; Valiani, S; Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 17; Document no.: CC120401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 91 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
CAC061802 RR
Question Submitted
June 18, 2020
Date Completed
July 21, 2020
Status
3. Completed
Research Team
Clinical/Acute Care
Report Review Title: What are the ethical principles that underlie pediatric triage protocols
Document Type
Rapid Review
Review Code
CAC061802 RR
Question Submitted
June 18, 2020
Date Completed
July 21, 2020
Status
3. Completed
Research Team
Clinical/Acute Care
Key Findings
· Key principles for the development of triage scoring systems are 1. Urgency 2. Survival 3. Likelihood of rapid benefit · Triage algorithms should be transparent and accessible, developed by teams with multiple perspectives/expertise · When all factors are equal, allocation should proceed by random/lottery assignment · Must balance egalitarian and utilitarian ideologies – providing equitable access while also providing the greatest benefit to the greatest number of people
Category
Healthcare Services
Administration
Subject
Ethics
Pediatrics
Triage
Acute Care
Population
All Pediatrics
Priority Level
Level 5 completed within 2 weeks
Cite As
Badea, A; Radu, L; Hansen, G; Dalidowicz, M; Howell-Spooner, B. What are the ethical principles that underlie pediatric triage protocols? 2020 Jul 21; Document no.: CAC061802 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 24 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
CAC061801 RR
Question Submitted
June 18, 2020
Date Completed
July 13, 2020
Status
3. Completed
Research Team
Clinical/Acute Care
Review Title: What are the pediatric triage protocols implemented during the COVID-19 pandemic, other
Document Type
Rapid Review
Review Code
CAC061801 RR
Question Submitted
June 18, 2020
Date Completed
July 13, 2020
Status
3. Completed
Research Team
Clinical/Acute Care
Key Findings
There are currently no validated pediatric triaging scored for COVID
Several US states have pandemic plans, and some pediatric specific for triage and scarce resource allocation
A number of pandemic plans include the use of PELOD-2 either in isolation or in combination with a mortality prognosis (survival > 1 year, death within 5 years despite successful treatment, death within 1 year despite successful treatment for ICU triage
While some states do not have pediatric-specific triage criteria, they do list young age as a prioritization category
Several sources discuss the ethics of scarce resource allocation and pediatric hospitals
Most recommend using a prioritization scale to save the most lives with the least resources vs. “first come, first serve” methods
Category
Healthcare Services
Administration
Subject
Pediatrics
Triage
Acute Care
Population
All Pediatrics
Priority Level
Level 5 completed within 2 weeks
Cite As
Badea, A; Groot, G; Howell-Spooner, B; Dalidowicz, M. What are the pediatric triage protocols implemented during the COVID-19 pandemic, other pandemics, or in other resource-scarce situations? 2020 Jul 13; Document no.: CAC061801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 23 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
CC120402 RR
Question Submitted
December 4, 2020
Date Completed
December 9, 2020
Status
3. Completed
Research Team
Critical Care
. A better understanding of predictors of mortality can aid in triage and resource allocation by providing
Document Type
Rapid Review
Review Code
CC120402 RR
Question Submitted
December 4, 2020
Date Completed
December 9, 2020
Status
3. Completed
Research Team
Critical Care
Key Findings
· A burgeoning body of research exists about factors associated with in-hospital mortality among COVID-19 patients; however, focus on intensive care settings remains limited. · The most frequent predictors of critical care mortality integrate age, physiologic markers and laboratory parameters in the most parsimonious models or prognostic scoring systems. · Commonly used prognostic scoring systems such as MEWS, APACHE and SOFA provide crude mortality risk prediction that may be improved with machine learning algorithms that potentially offer more clinically relevant windows and opportunities for mortality risk prediction prior to deterioration. Rapid Review Report: CC120402 RR (Version 1: December 9, 2020 14:51) 2 · Between centre variation is potentially an important determinant of critical care mortality that needs to be explored.
Category
Clinical Presentation
Subject
Critical Care
Triage
Population
All
All adults
Clinical Setting
ICU
Priority Level
Level 3 Two weeks (14 days)
Cite As
Williams-Roberts, H; Valiani, S; McLean, M; Miller, L; Howell-Spooner, B. What are the predictors of mortality in hospitalized COVID-19 patients? 2020 Dec 9; Document no.: CC120402 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
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6 records – page 1 of 1.