Triage protocols may increase racial disparities in treatment outcomes during COVID-19 pandemic

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During the COVID-19 pandemic crash, overwhelmed doctors and nurses in some places had to make agonizing decisions about which patients should receive scarce healthcare resources. However, two research studies led by Yale suggest that a standard measure designed to help predict which patients have the best chance of survival -; and who should therefore receive treatment -; could promote racial disparities in treatment outcomes.

In one of the studies, published September 16, researchers found that black patients admitted to Yale New Haven Health System hospitals with COVID-19 typically had organ failure sequential assessment scores ( SOFA) higher -; a measure developed two decades ago to predict the outcome of hospitalized patients with sepsis -; than white patients. (The higher a patient’s SOFA score, by standard, the lower their chances of survival.)

The other study showed that while black patients admitted to the Yale New Haven health care system tended to have higher SOFA scores than those of other racial or ethnic groups, their death rates were about the same. .

Both articles were published in the journal PLOS One.

“If we adopt this protocol, we could end up disproportionately shifting resources away from black patients and to other groups,” said Benjamin Tolchin, director of the Center for Clinical Ethics at Yale New Haven Health and corresponding author of the second. article, published on 17.

Since the early days of the pandemic, some healthcare facilities have been forced to triage patients based on limited stocks. During the first wave of infections in the spring of 2020, some hospitals in northern Italy and New York City were under staff and equipment -; such as ventilators and hemodialysis machines -; necessary to help all emergencies.

What happened was that clinicians were making resource allocation decisions on a case-by-case basis, with some preference given to younger patients who were less likely to die from severe infection. “

Benjamin Tolchin, Director, Center for Clinical Ethics at Yale New Haven Health

While some hospitals have started to consider the use of standard crisis protocols -; including those based on criteria such as SOFA scores -; in future crises, these protocols have rarely been used. In Idaho, however, doctors have been forced to ration medical care in response to the latest wave of infections and have adopted SOFA scores as the criteria for making those decisions.

Developed in 1996, the Sequential Organ Failure Assessment scoring system calculates the mortality of patients with sepsis based on the function of six organ systems.

“When we looked at this earlier this year, we were thinking about developing recommendations for crisis care standards that could be adopted in future pandemics,” Tolchin said. “We didn’t think we would need them so quickly.

Other lead authors of the papers include Carol Oladele, assistant professor in the section of general internal medicine at Yale and a faculty member at the university’s Equity Research and Innovation Center (ERIC), and Shireen Roy, a recent graduate of the Yale College and Yale. School of Public Health who is now a medical student at Washington University School of Medicine. Roy is the corresponding author of the article published on September 16.

Source:

Journal references:

  • Roy, S., et al. (2021) The Potential Impact of Triage Protocols on Racial Disparities in Clinical Outcomes in COVID-Positive Patients in a Large Academic Health System. PLOS ONE. doi.org/10.1371/journal.pone.0256763.
  • Tolchin, B., et al. (2021) Racial disparities in SOFA score among hospitalized patients with COVID-19. PLOS ONE. doi.org/10.1371/journal.pone.0257608.


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