Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies
Identifieur interne : 000988 ( Pmc/Curation ); précédent : 000987; suivant : 000989Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies
Auteurs : Sheri L. Fink [États-Unis]Source :
- Critical Care [ 1364-8535 ] ; 2010.
Abstract
Demand for critical care resources could vastly outstrip supply in an influenza pandemic or other health emergency, which has led expert groups to propose altered standards for triage and resource allocation. A pilot study by Christian and colleagues applied the Ontario, Canada draft critical care triage protocol to an actual retrospective cohort of intensive care unit patients. The findings are troubling. Patients who would have been triaged to expectant and designated for withdrawal of intensive care unit care and ventilator support in fact had substantial survival rates. Triage officers often disagreed and lacked confidence in their categorization decisions. These findings suggest that rationing paradigms which include categorical exclusion criteria and withdrawal of lifesaving resources should be reconsidered, and public input sought on nonclinical aspects.
Url:
DOI: 10.1186/cc8216
PubMed: 20122291
PubMed Central: 2875493
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Fink</name><affiliation wicri:level="1"><nlm:aff id="I1">Harvard Humanitarian Initiative, Harvard University, 14 Story Street, 2nd Floor, Cambridge, MA 02138, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard Humanitarian Initiative, Harvard University, 14 Story Street, 2nd Floor, Cambridge, MA 02138</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20122291</idno><idno type="pmc">2875493</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875493</idno><idno type="RBID">PMC:2875493</idno><idno type="doi">10.1186/cc8216</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000988</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000988</idno><idno type="wicri:Area/Pmc/Curation">000988</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000988</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies</title><author><name sortKey="Fink, Sheri L" sort="Fink, Sheri L" uniqKey="Fink S" first="Sheri L" last="Fink">Sheri L. Fink</name><affiliation wicri:level="1"><nlm:aff id="I1">Harvard Humanitarian Initiative, Harvard University, 14 Story Street, 2nd Floor, Cambridge, MA 02138, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard Humanitarian Initiative, Harvard University, 14 Story Street, 2nd Floor, Cambridge, MA 02138</wicri:regionArea></affiliation></author></analytic><series><title level="j">Critical Care</title><idno type="ISSN">1364-8535</idno><idno type="eISSN">1466-609X</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Demand for critical care resources could vastly outstrip supply in an influenza pandemic or other health emergency, which has led expert groups to propose altered standards for triage and resource allocation. A pilot study by Christian and colleagues applied the Ontario, Canada draft critical care triage protocol to an actual retrospective cohort of intensive care unit patients. The findings are troubling. Patients who would have been triaged to expectant and designated for withdrawal of intensive care unit care and ventilator support in fact had substantial survival rates. Triage officers often disagreed and lacked confidence in their categorization decisions. These findings suggest that rationing paradigms which include categorical exclusion criteria and withdrawal of lifesaving resources should be reconsidered, and public input sought on nonclinical aspects.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Christian, Md" uniqKey="Christian M">MD Christian</name></author><author><name sortKey="Hamielec, C" uniqKey="Hamielec C">C Hamielec</name></author><author><name sortKey="Lazar, Nm" uniqKey="Lazar N">NM Lazar</name></author><author><name sortKey="Wax, Rs" uniqKey="Wax R">RS Wax</name></author><author><name sortKey="Griffith, L" uniqKey="Griffith L">L Griffith</name></author><author><name sortKey="Herridge, Ms" uniqKey="Herridge M">MS Herridge</name></author><author><name sortKey="Lee, D" uniqKey="Lee D">D Lee</name></author><author><name sortKey="Cook, Dj" uniqKey="Cook D">DJ Cook</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Christian, Md" uniqKey="Christian M">MD Christian</name></author><author><name sortKey="Hawryluck, L" uniqKey="Hawryluck L">L Hawryluck</name></author><author><name sortKey="Wax, Rs" uniqKey="Wax R">RS Wax</name></author><author><name sortKey="Cook, T" uniqKey="Cook T">T Cook</name></author><author><name sortKey="Lazar, Nm" uniqKey="Lazar N">NM Lazar</name></author><author><name sortKey="Herridge, Ms" uniqKey="Herridge M">MS Herridge</name></author><author><name sortKey="Muller, Mp" uniqKey="Muller M">MP Muller</name></author><author><name sortKey="Gowans, Dr" uniqKey="Gowans D">DR Gowans</name></author><author><name sortKey="Fortier, W" uniqKey="Fortier W">W Fortier</name></author><author><name sortKey="Burkle, Fm" uniqKey="Burkle F">FM Burkle</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kumar, A" uniqKey="Kumar A">A Kumar</name></author><author><name sortKey="Zarychanski, R" uniqKey="Zarychanski R">R Zarychanski</name></author><author><name sortKey="Pinto, R" uniqKey="Pinto R">R Pinto</name></author><author><name sortKey="Cook, Dj" uniqKey="Cook D">DJ Cook</name></author><author><name sortKey="Marshall, J" uniqKey="Marshall J">J Marshall</name></author><author><name sortKey="Lacroix, J" uniqKey="Lacroix J">J Lacroix</name></author><author><name sortKey="Stelfox, T" uniqKey="Stelfox T">T Stelfox</name></author><author><name sortKey="Bagshaw, S" uniqKey="Bagshaw S">S Bagshaw</name></author><author><name sortKey="Choong, K" uniqKey="Choong K">K Choong</name></author><author><name sortKey="Lamontagne, F" uniqKey="Lamontagne F">F Lamontagne</name></author><author><name sortKey="Tergeon, Af" uniqKey="Tergeon A">AF Tergeon</name></author><author><name sortKey="Lapinsky, S" uniqKey="Lapinsky S">S Lapinsky</name></author><author><name sortKey="Ahern, Sp" uniqKey="Ahern S">SP Ahern</name></author><author><name sortKey="Smith, O" uniqKey="Smith O">O Smith</name></author><author><name sortKey="Siddiqui, F" uniqKey="Siddiqui F">F Siddiqui</name></author><author><name sortKey="Jouvet, P" uniqKey="Jouvet P">P Jouvet</name></author><author><name sortKey="Khwaia, K" uniqKey="Khwaia K">K Khwaia</name></author><author><name sortKey="Mcintryre, L" uniqKey="Mcintryre L">L McIntryre</name></author><author><name sortKey="Menon, K" uniqKey="Menon K">K Menon</name></author><author><name sortKey="Hutchison, J" uniqKey="Hutchison J">J Hutchison</name></author><author><name sortKey="Hornstein, D" uniqKey="Hornstein D">D Hornstein</name></author><author><name sortKey="Joffe, A" uniqKey="Joffe A">A Joffe</name></author><author><name sortKey="Lauzier, F" uniqKey="Lauzier F">F Lauzier</name></author><author><name sortKey="Singh, J" uniqKey="Singh J">J Singh</name></author><author><name sortKey="Karachi, T" uniqKey="Karachi T">T Karachi</name></author><author><name sortKey="Wiebe, K" uniqKey="Wiebe K">K Wiebe</name></author><author><name sortKey="Olafson, K" uniqKey="Olafson K">K Olafson</name></author><author><name sortKey="Ramsey, C" uniqKey="Ramsey C">C Ramsey</name></author><author><name sortKey="Sharma, S" uniqKey="Sharma S">S Sharma</name></author><author><name sortKey="Dodek, P" uniqKey="Dodek P">P Dodek</name></author><author><name sortKey="Meade, M" uniqKey="Meade M">M Meade</name></author><author><name sortKey="Hall, R" uniqKey="Hall R">R Hall</name></author><author><name sortKey="Fowler, Ra" uniqKey="Fowler R">RA Fowler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fink, Sl" uniqKey="Fink S">SL Fink</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Altevogt, Bm" uniqKey="Altevogt B">BM Altevogt</name></author><author><name sortKey="Stroud, C" uniqKey="Stroud C">C Stroud</name></author><author><name sortKey="Hanson, Sl" uniqKey="Hanson S">SL Hanson</name></author><author><name sortKey="Hanfling, D" uniqKey="Hanfling D">D Hanfling</name></author><author><name sortKey="Gostin, Lo" uniqKey="Gostin L">LO 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Crit Care</journal-id><journal-title-group><journal-title>Critical Care</journal-title></journal-title-group><issn pub-type="ppub">1364-8535</issn><issn pub-type="epub">1466-609X</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20122291</article-id><article-id pub-id-type="pmc">2875493</article-id><article-id pub-id-type="publisher-id">cc8216</article-id><article-id pub-id-type="doi">10.1186/cc8216</article-id><article-categories><subj-group subj-group-type="heading"><subject>Commentary</subject></subj-group></article-categories><title-group><article-title>Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Fink</surname><given-names>Sheri L</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>sfink@hsph.harvard.edu</email></contrib></contrib-group><aff id="I1"><label>1</label>Harvard Humanitarian Initiative, Harvard University, 14 Story Street, 2nd Floor, Cambridge, MA 02138, USA</aff><pub-date pub-type="ppub"><year>2010</year></pub-date><pub-date pub-type="epub"><day>21</day><month>1</month><year>2010</year></pub-date><pmc-comment> PMC Release delay is 12 months and 0 days and was based on the epub date.</pmc-comment>
<pub-date pub-type="pmc-release"><day>21</day><month>1</month><year>2011</year></pub-date><volume>14</volume><issue>1</issue><fpage>103</fpage><lpage>103</lpage><permissions><copyright-statement>Copyright ©2010 BioMed Central Ltd</copyright-statement><copyright-year>2010</copyright-year><copyright-holder>BioMed Central Ltd</copyright-holder></permissions><self-uri xlink:href="http://ccforum.com/content/14/1/103"></self-uri><abstract><p>Demand for critical care resources could vastly outstrip supply in an influenza pandemic or other health emergency, which has led expert groups to propose altered standards for triage and resource allocation. A pilot study by Christian and colleagues applied the Ontario, Canada draft critical care triage protocol to an actual retrospective cohort of intensive care unit patients. The findings are troubling. Patients who would have been triaged to expectant and designated for withdrawal of intensive care unit care and ventilator support in fact had substantial survival rates. Triage officers often disagreed and lacked confidence in their categorization decisions. These findings suggest that rationing paradigms which include categorical exclusion criteria and withdrawal of lifesaving resources should be reconsidered, and public input sought on nonclinical aspects.</p></abstract></article-meta><notes><p>See related research by Christian <italic>et al.</italic>, <ext-link ext-link-type="uri" xlink:href="http://ccforum.com/content/13/5/R170">http://ccforum.com/content/13/5/R170</ext-link> and related letter by Burkle, <ext-link ext-link-type="uri" xlink:href="http://ccforum.com/content/14/1/401">http://ccforum.com/content/14/1/401</ext-link></p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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