ABSTRACT
OBJECTIVES: To develop and validate a triage scale (Spanish acronym, TIHCOVID) to assign priority by predicting critical events in patients with severe COVID-19 who are candidates for interhospital transfer. MATERIAL AND METHODS: Prospective cohort study in 2 periods for internal (February-April 2020) and external (October-December 2020) validation. We included consecutive patients with severe COVID-19 who were transported by the emergency medical service of Catalonia. A risk model was developed to predict mortality based on variables recorded on first contact between the regional emergency coordination center and the transferring hospital. The model's performance was evaluated by means of calibration and discrimination, and the results for the first and second periods were compared. RESULTS: Nine hundred patients were included, 450 in each period. In-hospital mortality was 33.8%. The 7 predictors included in the final model were age, comorbidity, need for prone positioning, renal insufficiency, use of high-flow nasal oxygen prior to mechanical ventilation, and a ratio of PaO2 to inspired oxygen fraction of less than 50. The performance of the model was good (Brier score, 0.172), and calibration and discrimination were consistent. We found no significant differences between the internal and external validation steps with respect to either the calibration slopes (0.92 [95% CI, 0.91-0.93] vs 1.12 [95% CI, 0.6-1.17], respectively;P = .150) or discrimination (area under the curve, 0.81 [95% CI, 0.75-0.84] vs 0.85 [95% CI, 0.81-0.89];P = .121). CONCLUSION: The TIHCOVID tool may be useful for triage when assigning priority for patients with severe COVID-19 who require transfer between hospitals.
ABSTRACT
In view of the exceptional public health situation caused by the COVID-19 pandemic, a consensus work has been promoted from the ethics group of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC), with the objective of finding some answers from ethics to the crossroads between the increase of people with intensive care needs and the effective availability of means.In a very short period, the medical practice framework has been changed to a 'catastrophe medicine' scenario, with the consequent change in the decision-making parameters. In this context, the allocation of resources or the prioritization of treatment become crucial elements, and it is important to have an ethical reference framework to be able to make the necessary clinical decisions. For this, a process of narrative review of the evidence has been carried out, followed by a unsystematic consensus of experts, which has resulted in both the publication of a position paper and recommendations from SEMICYUC itself, and the consensus between 18 scientific societies and 5 institutes/chairs of bioethics and palliative care of a framework document of reference for general ethical recommendations in this context of crisis.