Variability in triage practices for critically ill cancer patients: A randomized controlled trial

• Published in: Journal of critical care 2019-10, Vol.53, p.18-24
• Main Authors: Rathi, Nisha K., Haque, Sajid A., Morales, Freddy, Kaul, Bhavika, Ramirez, Rafael, Ovu, Steven, Feng, Lei, Dong, Wenli, Price, Kristen J., Ugarte, Sebastian, Raimondi, Nestor, Quintero, Agamenon, Cardenas, Yenny R., Nates, Joseph L.
• Format: Article
• Language: English
• Subjects: Agreements; Cancer; Clinical decision making; Critical care; Decision making; Evidence-based medicine; Guidelines; Intensive care; Intensive care unit triage; Medicine; Oncology; Patients; Variability
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.05.012

Intensive care triage practices and end-user interpretation of triage guidelines have rarely been assessed. We evaluated agreement between providers on the prioritization of patients for ICU admission using different triage guidelines. A multi-centered randomized study on providers from 18 different countries was conducted using clinical vignettes of oncological patients. The level of agreement between providers was measured using two different guidelines, with one being cancer specific. Amongst 257 providers, 52.5% randomly received the Society of Critical Care Prioritization Model, and 47.5% received a cancer specific flowchart as a guide. In the Prioritization Model arm the average entropy was 1.193, versus 1.153 in the flowchart arm (P = .095) indicating similarly poor agreement. The Fleiss' kappa coefficients were estimated to be 0.2136 for the SCCMPM arm and 0.2457 for the flowchart arm, also similarly implying poor agreement. The low agreement amongst practitioners on the prioritization of cancer patient cases for ICU admission existed using both general triage guidelines and guidelines tailored only to cancer patients. The lack of consensus on intensive care unit triage practices in the oncological population exposes a potential barrier to appropriate resource allocation that needs to be addressed. •Randomized multi-centered study on ICU triage practices•15 clinical vignettes of critically ill cancer patients distributed to providers•Providers randomized to a general guideline and cancer-specific flow chart•Poor agreement noted amongst providers regardless of guideline used•Lack of consensus could be a barrier to appropriate resource allocation