Skip to main content Accessibility help
×
Home

A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

  • Colin K. Grissom, Samuel M. Brown, Kathryn G. Kuttler, Jonathan P. Boltax, Jason Jones, Al R. Jephson and James F. Orme...

Abstract

Objective: The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score.

Methods: After a retrospective derivation in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during the 2008 calendar year and compared the ability to predict mortality and the need for mechanical ventilation.

Results: A total of 1770 patients (56% male patients) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% confidence interval 0.81-.85) and 0.84 (95% confidence interval 0.82-.85), respectively (P = .33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the intensive care unit with an AUC of 0.78 and 0.79, respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted the need for mechanical ventilation on day 3, with an AUC of 0.83 and 0.82, respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58%, respectively.

Conclusions: The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.

(Disaster Med Public Health Preparedness. 2010;4:277-284)

Copyright

Corresponding author

Correspondence: Address correspondence and reprint requests to Dr Colin K. Grissom, Critical Care Medicine, Intermountain Medical Center, 5121 South Cottonwood St, Murray, UT 84107 (e-mail: colin.grissom@imail.org).

References

Hide All
1.Ferreira, FL, Bota, DP, Bross, A, Mélot, C, Vincent, JL.Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286 (14):17541758.
2.Vincent, JL, Moreno, R, Takala, J, et alThe SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22 (7):707710.
3.Cabré, L, Mancebo, J, Solsona, JF, et aland the Bioethics Working Group of the SEMICYUC. Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making. Intensive Care Med. 2005;31 (7):927933.
4.Hick, JL, O’Laughlin, DT.Concept of operations for triage of mechanical ventilation in an epidemic. Acad Emerg Med. 2006;13 (2):223229.
5.Christian, MD, Hawryluck, L, Wax, RS, et alDevelopment of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175 (11):13771381.
6.Powell, T, Christ, KC, Birkhead, GS.Allocation of ventilators in a public health disaster. Disaster Med Public Health Prep. 2008;2 (1):2026.
7.Devereaux, AV, Dichter, JR, Christian, MD, et alTask Force for Mass Critical Care. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133 5(Suppl)51S66S.
8.Utah Hospitals and Health Systems Association. Utah pandemic influenza hospital and ICU triage guidelines. http://www.uha-utah.org/DisasterPrep.htm. Accessed September 4, 2009.
9.Rice, TW, Wheeler, AP, Bernard, GR, Hayden, DL, Schoenfeld, DA, Ware, LBfor the National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Network. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest. 2007;132 (2):410417.
10.Pandharipande, PP, Shintani, AK, Hagerman, HE, et alDerivation and validation of SpO2/FiO2 ratio to impute for PaO2/FiO2 ratio in the respiratory component of the Sequential Organ Failure Assessment score. Crit Care Med. 2009;37 (4):13171321.
11.DeLong, ER, DeLong, DM, Clarke-Pearson, DL.Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44 (3):837845.
12.Efron, B, Tibshirani, RJ.Improvements on cross-validation: the. 632+ bootstrap method. J Am Stat Assoc. 1997;92:548560.
13.Harrell, FE JrRegression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York: Springer; 2001.
14.Chowell, G, Bertozzi, SM, Colchero, MA, et alSevere respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med. 2009;361 (7):674679.
15.Perez-Padilla, R, de la Rosa-Zamboni, D, Ponce de Leon, S, et alINER Working Group on Influenza. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009;361 (7):680689.
16.Abdel-Ghafar, AN, Chotpitayasunondh, T, Gao, Z, et alWriting Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus. Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med. 2008;358 (3):261273.
17.Arabi, Y, Gomersall, CD, Ahmed, QA, Boynton, BR, Memish, ZA.The critically ill avian influenza A (H5N1) patient. Crit Care Med. 2007;35 (5):13971403.
18.Beigel, JH, Farrar, J, Han, AM, et alWriting Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5. Avian influenza A (H5N1) infection in humans. N Engl J Med. 2005;353 (13):13741385.
19.Gruber, PC, Gomersall, CD, Joynt, GM.Avian influenza (H5N1): implications for intensive care. Intensive Care Med. 2006;32 (6):823829.
20.Bartlett, JG.Planning for avian influenza. Ann Intern Med. 2006;145 (2):141144.
21.Talmor, D, Jones, AE, Rubinson, L, Howell, MD, Shapiro, NI.Simple triage scoring system predicting death and the need for critical care resources for use during epidemics. Crit Care Med. 2007;35 (5):12511256.
22.Carr, BG, Addyson, DK, Kahn, JM.Variation in critical care beds per capita in the United States: implications for pandemic and disaster planning. JAMA. 2010;303 (14):13711372.
23.Le Gall, JR, Lemeshow, S, Leleu, G, et alIntensive Care Unit Scoring Group. Customized probability models for early severe sepsis in adult intensive care patients. JAMA. 1995;273 (8):644650.
24.Lemeshow, S, Le Gall, JR.Modeling the severity of illness of ICU patients. A systems update. JAMA. 1994;272 (13):10491055.
25.Garner, A, Lee, A, Harrison, K, Schultz, CH.Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001;38 (5):541548.
26.Christian, MD, Joynt, GM, Hick, JL, Colvin, J, Danis, M, Sprung, CLEuropean Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010;36(Suppl 1)S55S64.
27.Halim, DA, Murni, TW, Redjeki, IS.Comparison of Apache II, SOFA, and Modified SOFA scores in predicting mortality of surgical patients in intensive care unit at Dr. Hasan Sadikin General Hospital. Crit Care Shock. 2009;12:157169.
28.Christian, MD, Hamielec, C, Lazar, NM, et alA retrospective cohort pilot study to evaluate a triage tool for use in a pandemic. Crit Care. 2009;13 (5):R17019874595.
29.Khan, Z, Hulme, J, Sherwood, N.An assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic. Anaesthesia. 2009;64 (12):12831288.
30.Guest, T, Tantam, G, Donlin, N, Tantam, K, McMillan, H, Tillyard, A.An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidence based medicine’? Anaesthesia. 2009;64 (11):11991206.
31.Christian, MD, Sandrock, CE, Devereaux, A, Geiling, J, Amundson, DE, Rubinson, L.Ethical issues and the allocation of scarce resources during a public health emergency. Ann Intern Med. 2009;150 (12):890891,author reply 891-89219528573.
32.White, DB, Katz, MH, Luce, JM, Lo, B.Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009;150 (2):132138.
33.Fink, SL.Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies. Crit Care. 2010;14 (1):10320122291.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed