A modified sequential organ failure assessment score for critical care triage

Area of Science:

• Critical Care Medicine
• Health Services Research
• Clinical Triage Tools

Background:

• The Sequential Organ Failure Assessment (SOFA) score is recommended for mass casualty triage.
• SOFA requires laboratory measurements, posing challenges in resource-constrained environments.
• An alternative, modified SOFA (MSOFA) score using fewer labs was developed.

Purpose of the Study:

• To evaluate if the modified SOFA (MSOFA) score predicts patient outcomes as effectively as the standard SOFA score.
• To assess the utility of MSOFA in predicting mortality and mechanical ventilation needs.
• To determine the feasibility of MSOFA in resource-limited settings.

Main Methods:

• Retrospective derivation in a prospective observational study.
• Serial SOFA and MSOFA scores were collected for ICU patients over one year.
• Predictive accuracy for mortality and mechanical ventilation was compared using receiver operating characteristic curves.

Main Results:

• Day 1 SOFA and MSOFA scores showed comparable accuracy in predicting mortality (AUC 0.83 vs 0.84).
• Both scores accurately predicted the need for mechanical ventilation by Day 3 (AUC 0.83 vs 0.82).
• Higher SOFA and MSOFA scores correlated with increased mortality rates (53% vs 58% for >11 points).

Conclusions:

• The MSOFA score demonstrates comparable predictive performance to the SOFA score for patient outcomes.
• MSOFA is a viable alternative in resource-limited settings due to its simplified laboratory requirements.
• While useful, both scores may exclude patients who could potentially survive if treated.