Guest T, Tantam G, Donlin N, Tantam K, McMillan H, Tillyard A
Anaesthesia and Intensive Care Medicine, Department of Critical Care, Derriford Hospital, Plymouth, UK.
Anaesthesia. 2009 Nov;64(11):1199-206. doi: 10.1111/j.1365-2044.2009.06084.x.
We assessed the impact of a United Kingdom government-recommended triage process, designed to guide the decision to admit patients to intensive care during an influenza pandemic, on patients in a teaching hospital intensive care unit. We found that applying the triage criteria to a current case-mix would result in 116 of the 255 patients (46%) admitted during the study period being denied intensive care treatment they would have otherwise received, of which 45 (39%) survived to hospital discharge. In turn, 69% of those categorised as too ill to warrant admission according to the criteria survived. The sensitivity and specificity of the triage category at ICU admission predicting mortality was 0.29 and 0.84, respectively. If the need for intensive care beds is estimated to be 275 patients per week, the triage criteria would not exclude enough patients to prevent the need for further rationing. We conclude that the proposed triage tool failed adequately to prioritise patients who would benefit from intensive care.
我们评估了英国政府推荐的一种分诊流程对一家教学医院重症监护病房患者的影响，该流程旨在指导在流感大流行期间决定患者是否入住重症监护病房。我们发现，将分诊标准应用于当前的病例组合，会导致在研究期间入院的255名患者中有116名（46%）被拒绝接受原本会得到的重症监护治疗，其中45名（39%）存活至出院。反过来，根据标准被归类为病情过重而无入院必要的患者中，69%存活了下来。在重症监护病房入院时，分诊类别预测死亡率的敏感性和特异性分别为0.29和0.84。如果估计每周对重症监护床位的需求为275名患者，分诊标准无法排除足够多的患者以避免进一步的资源分配。我们得出结论，所提议的分诊工具未能充分对那些将从重症监护中受益的患者进行优先排序。
