TY - JOUR
T1 - Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
AU - the STOP-COVID Investigators
AU - Jezmir, Julia L.
AU - Bharadwaj, Maheetha
AU - Chaitoff, Alexander
AU - Diephuis, Bradford
AU - Crowley, Conor P.
AU - Kishore, Sandeep P.
AU - Goralnick, Eric
AU - Merriam, Louis T.
AU - Milliken, Aimee
AU - Rhee, Chanu
AU - Sadovnikoff, Nicholas
AU - Shah, Sejal B.
AU - Gupta, Shruti
AU - Leaf, David E.
AU - Feldman, William B.
AU - Kim, Edy Y.
AU - Walther, Carl P.
AU - Anumudu, Samaya J.
AU - Arunthamakun, Justin
AU - Kopecky, Kathleen F.
AU - Milligan, Gregory P.
AU - McCullough, Peter A.
AU - Nguyen, Thuy Duyen
AU - Shaefi, Shahzad
AU - Krajewski, Megan L.
AU - Shankar, Sidharth
AU - Pannu, Ameeka
AU - Valencia, Juan D.
AU - Waikar, Sushrut S.
AU - Kibbelaar, Zoe A.
AU - Athavale, Ambarish M.
AU - Hart, Peter
AU - Upadhyay, Shristi
AU - Vohra, Ishaan
AU - Oyintayo, Ajiboye
AU - Green, Adam
AU - Rachoin, Jean Sebastien
AU - Schorr, Christa A.
AU - Shea, Lisa
AU - Edmonston, Daniel L.
AU - Mosher, Christopher L.
AU - Shehata, Alexandre M.
AU - Cohen, Zaza
AU - Allusson, Valerie
AU - Bambrick-Santoyo, Gabriela
AU - ul aain Bhatti, Noor
AU - Mehta, Bijal
AU - Williams, Aquino
AU - Brenner, Samantha K.
AU - Walters, Patricia
AU - Go, Ronaldo C.
AU - Rose, Keith M.
AU - Hernán, Miguel A.
AU - Zhou, Amy M.
AU - Kim, Ethan C.
AU - Lisk, Rebecca
AU - Chan, Lili
AU - Mathews, Kusum S.
AU - Coca, Steven G.
AU - Altman, Deena R.
AU - Saha, Aparna
AU - Soh, Howard
AU - Wen, Huei Hsun
AU - Bose, Sonali
AU - Leven, Emily A.
AU - Wang, Jing G.
AU - Mosoyan, Gohar
AU - Nadkarni, Girish N.
AU - Pattharanitima, Pattharawin
AU - Friedman, Allon N.
AU - Guirguis, John
AU - Kapoor, Rajat
AU - Meshberger, Christopher
AU - Kelly, Katherine J.
AU - Parikh, Chirag R.
AU - Garibaldi, Brian T.
AU - Corona-Villalobos, Celia P.
AU - Wen, Yumeng
AU - Menez, Steven
AU - Malik, Rubab F.
AU - Cervantes, Elena
AU - Gautam, Samir
AU - Mallappallil, Mary C.
AU - Ouyang, Jie
AU - John, Sabu
AU - Yap, Ernie
AU - Melaku, Yohannes
AU - Mohamed, Ibrahim
AU - Bajracharya, Siddartha
AU - Puri, Isha
AU - Thaxton, Mariah
AU - Bhattacharya, Jyotsna
AU - Wagner, John
AU - Boudourakis, Leon
AU - Nguyen, H. Bryant
AU - Ahoubim, Afshin
AU - Thomas, Leslie F.
AU - Sirganagari, Dheeraj Reddy
AU - Guru, Pramod K.
AU - Kashani, Kianoush
AU - Zhou, Yan
AU - Bergl, Paul A.
AU - Rodriguez, Jesus
AU - Shah, Jatan A.
AU - Gupta, Mrigank S.
AU - Kumar, Princy N.
AU - Lazarous, Deepa G.
AU - Kassaye, Seble G.
AU - Melamed, Michal L.
AU - Johns, Tanya S.
AU - Mocerino, Ryan
AU - Prudhvi, Kalyan
AU - Zhu, Denzel
AU - Levy, Rebecca V.
AU - Azzi, Yorg
AU - Fisher, Molly
AU - Yunes, Milagros
AU - Sedaliu, Kaltrina
AU - Golestaneh, Ladan
AU - Brogan, Maureen
AU - Kumar, Neelja
AU - Chang, Michael
AU - Raichoudhury, Ritesh
AU - Athreya, Akshay
AU - Farag, Mohamed
AU - Schenck, Edward J.
AU - Cho, Soo Jung
AU - Plataki, Maria
AU - Alvarez-Mulett, Sergio L.
AU - Gomez-Escobar, Luis G.
AU - Pan, Di
AU - Lee, Stefi
AU - Krishnan, Jamuna
AU - Whalen, William
AU - Charytan, David
AU - Macina, Ashley
AU - Chaudhry, Sobaata
AU - Wu, Benjamin
AU - Modersitzki, Frank
AU - Srivastava, Anand
AU - Leidner, Alexander S.
AU - Martinez, Carlos
AU - Kruser, Jacqueline M.
AU - Wunderink, Richard G.
AU - Hodakowski, Alexander J.
AU - Velez, Juan Carlos Q.
AU - Price-Haywood, Eboni G.
AU - Matute-Trochez, Luis A.
AU - Hasty, Anna E.
AU - Mohamed, Muner MB
AU - Avasare, Rupali S.
AU - Zonies, David
AU - Sise, Meghan E.
AU - Newman, Erik T.
AU - Abu Omar, Samah
AU - Pokharel, Kapil K.
AU - Sharma, Shreyak
AU - Singh, Harkarandeep
AU - Correa, Simon
AU - Shaukat, Tanveer
AU - Kamal, Omer
AU - Wang, Wei
AU - Yang, Heather
AU - Boateng, Jeffery O.
AU - Lee, Meghan
AU - Strohbehn, Ian A.
AU - Li, Jiahua
AU - Mueller, Ariel L.
AU - Redfern, Roberta
AU - Cairl, Nicholas S.
AU - Naimy, Gabriel
AU - Abu-Saif, Abeer
AU - Hall, Danyell
AU - Bickley, Laura
AU - Rowan, Chris
AU - Madhani-Lovely, Farah
AU - Cruz, Vivian S.
AU - Hess, Kristen M.
AU - Jacobs, Alanna L.
AU - Peev, Vasil
AU - Reiser, Jochen
AU - Byun, John J.
AU - Vissing, Andrew
AU - Kapania, Esha M.
AU - Post, Zoe
AU - Patel, Nilam P.
AU - Hermes, Joy Marie
AU - Sutherland, Anne K.
AU - Patrawalla, Amee
AU - Finkel, Diana G.
AU - Danek, Barbara A.
AU - Arikapudi, Sowminya
AU - Paer, Jeffrey M.
AU - Cangialosi, Peter
AU - Liotta, Mark
AU - Radbel, Jared
AU - Puri, Sonika
AU - Vijayan, Anitha
AU - Goldberg, Seth
AU - Kao, Patricia F.
N1 - Publisher Copyright:
© 2021 The Author(s)
PY - 2021/9/21
Y1 - 2021/9/21
N2 - Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.
AB - Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.
KW - ARDS
KW - COVID-19
KW - acute respiratory distress syndrome
KW - crisis standards of care
KW - critical care
KW - intensive care
KW - medical ethics
KW - triage
UR - http://www.scopus.com/inward/record.url?scp=85114109454&partnerID=8YFLogxK
U2 - 10.1016/j.xcrm.2021.100376
DO - 10.1016/j.xcrm.2021.100376
M3 - Article
C2 - 34337554
AN - SCOPUS:85114109454
SN - 2666-3791
VL - 2
JO - Cell Reports Medicine
JF - Cell Reports Medicine
IS - 9
M1 - 100376
ER -