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Practices in Triage and Transfer of Critically Ill Patients: A Qualitative Systematic Review of Selection Criteria.
Dahine, Joseph; Hébert, Paul C; Ziegler, Daniela; Chenail, Noémie; Ferrari, Nicolay; Hébert, Réjean.
  • Dahine J; Département de médecine spécialisée, Centre intégré de santé et services sociaux de Laval (CISSS de Laval), Hôpital Cité-de-la-Santé, Université de Montréal, Laval, QC, Canada.
  • Hébert PC; Département de médecine, Centre Hospitalier de l'Université de Montréal, Université de Montréal et Centre de Recherche, Montreal, QC, Canada.
  • Ziegler D; Bibliothèque, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
  • Chenail N; Université de Montréal, Montreal, QC, Canada.
  • Ferrari N; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
  • Hébert R; Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montreal, QC, Canada.
Crit Care Med ; 48(11): e1147-e1157, 2020 11.
Article in English | MEDLINE | ID: covidwho-733343
ABSTRACT

OBJECTIVES:

To identify and appraise articles describing criteria used to prioritize or withhold a critical care admission. DATA SOURCES PubMed, Embase, Medline, EBM Reviews, and CINAHL Complete databases. Gray literature searches and a manual review of references were also performed. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. STUDY SELECTION We sought all articles and abstracts of original research as well as local, provincial, or national policies on the topic of ICU resource allocation. We excluded studies whose population of interest was neonatal, pediatric, trauma, or noncritically ill. Screening of 6,633 citations was conducted. DATA EXTRACTION Triage and/or transport criteria were extracted, based on type of article, methodology, publication year, and country. An appraisal scale was developed to assess the quality of identified articles. We also developed a robustness score to further appraise the robustness of the evidence supporting each criterion. Finally, all criteria were extracted, evaluated, and grouped by theme. DATA

SYNTHESIS:

One-hundred twenty-nine articles were included. These were mainly original research (34%), guidelines (26%), and reviews (21%). Among them, we identified 200 unique triage and transport criteria. Most articles highlighted an exclusion (71%) rather than a prioritization mechanism (17%). Very few articles pertained to transport of critically ill patients (4%). Criteria were classified in one of four emerging themes patient, condition, physician, and context. The majority of criteria used were nonspecific. No study prospectively evaluated the implementation of its cited criteria.

CONCLUSIONS:

This systematic review identified 200 criteria classified within four themes that may be included when devising triage programs including the coronavirus disease 2019 pandemic. We identified significant knowledge gaps where research would assist in improving existing triage criteria and guidelines, aiming to decrease arbitrary decisions and variability.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Triage / Patient Transfer / Critical Illness / Coronavirus Infections / Critical Care / Intensive Care Units Type of study: Experimental Studies / Prognostic study / Qualitative research / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Crit Care Med Year: 2020 Document Type: Article Affiliation country: CCM.0000000000004624

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Triage / Patient Transfer / Critical Illness / Coronavirus Infections / Critical Care / Intensive Care Units Type of study: Experimental Studies / Prognostic study / Qualitative research / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Crit Care Med Year: 2020 Document Type: Article Affiliation country: CCM.0000000000004624