Research

A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic

Michael D Christian¹ , Cindy Hamielec² , Neil M Lazar³ , Randy S Wax⁴ , Lauren Griffith⁵ , Margaret S Herridge³ , David Lee⁶ and Deborah J Cook⁷

¹Department of National Defence -- Canadian Forces, Mount Sinai Hospital Toronto/University Health Network, University of Toronto, 600 University Avenue, Toronto, ON, Canada, M5G 1X5

²Hamilton Health Sciences Corporation, McMaster University, 237 Barton Street East, Hamilton, ON, Canada, L8L 2X2

³University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada, M5G 2C4

⁴Mount Sinai Hospital Toronto, University of Toronto, 600 University Avenue, Toronto, ON, Canada, M5G 1X5

⁵McMaster University, 1280 Main Street West, Hamilton, ON, Canada, L8S4L8

⁶University of Toronto, 600 University Avenue, Toronto, ON, Canada, M5G 1X5

⁷St Josephs Health Care Centre, McMaster University, 50 Charlton Avenue East, Hamilton, ON, Canada, L8N 4A6

author email corresponding author email

Critical Care 2009, 13:R170doi:10.1186/cc8146

Published:	29 October 2009

Abstract

Introduction

The objective of this pilot study was to assess the usability of the draft Ontario triage protocol, to estimate its potential impact on patient outcomes, and ability to increase resource availability based on a retrospective cohort of critically ill patients cared for during a non-pandemic period.

Methods

Triage officers applied the protocol prospectively to 2 retrospective cohorts of patients admitted to 2 academic medical/surgical ICUs during an 8 week period of peak occupancy. Each patient was assigned a treatment priority (red -- 'highest', yellow -- 'intermediate', green -- 'discharge to ward', or blue/black -- 'expectant') by the triage officers at 3 separate time points (at the time of admission to the ICU, 48, and 120 hours post admission).

Results

Overall, triage officers were either confident or very confident in 68.4% of their scores; arbitration was required in 54.9% of cases. Application of the triage protocol would potentially decrease the number of required ventilator days by 49.3% (568 days) and decrease the total ICU days by 52.6% (895 days). On the triage protocol at ICU admission the survival rate in the red (93.7%) and yellow (62.5%) categories were significantly higher then that of the blue category (24.6%) with associated P values of < 0.0001 and 0.0003 respectively. Further, the survival rate of the red group was significantly higher than the overall survival rate of 70.9% observed in the cohort (P < 0.0001). At 48 and 120 hours, survival rates in the blue group increased but remained lower then the red or yellow groups.

Conclusions

Refinement of the triage protocol and implementation is required prior to future study, including improved training of triage officers, and protocol modification to minimize the exclusion from critical care of patients who may in fact benefit. However, our results suggest that the triage protocol can help to direct resources to patients who are most likely to benefit, and help to decrease the demands on critical care resources, thereby making available more resources to treat other critically ill patients.