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Sequential Organ Failure Assessment in H1N1 pandemic planning
Reza Shahpori1, H Tom Stelfox, Christopher J Doig
1Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
Critical Care Medicine
|January 26, 2011
Summary
A Sequential Organ Failure Assessment score above 11 does not predict >90% mortality. This score is not a reliable triage tool for critical care, even during pandemics like H1N1.
Area of Science:
- Critical care medicine
- Public health
- Epidemiology
Background:
- The H1N1 pandemic underscored the need for effective critical care triage tools.
- A Sequential Organ Failure Assessment (SOFA) score >11 has been proposed as a threshold for excluding patients from critical care, citing >90% mortality.
- This study evaluates the mortality associated with this SOFA threshold and its implications for resource allocation during pandemics.
Purpose of the Study:
- To assess the actual hospital mortality for patients with an initial Sequential Organ Failure Assessment (SOFA) score >11.
- To evaluate the utility of a SOFA score >11 as a triage instrument for critical care resource allocation, particularly in pandemic scenarios.
- To compare the characteristics and outcomes of H1N1 patients with non-H1N1 patients in intensive care units.
Main Methods:
- Retrospective cohort study involving three multisystem intensive care units.
- Analysis of consecutive patients admitted between January 2003 and December 2008, with a comparison H1N1 cohort from 2009.
- Daily SOFA scores collected via an electronic bedside clinical information system for 10,204 patients (69,913 patient days).
Main Results:
- The overall hospital mortality for patients with an initial SOFA score >11 was 59%, not >90%.
- Hospital mortality exceeded 90% only when the initial SOFA score was >20, observed in only 0.2% of patients.
- For H1N1 patients with an initial SOFA score >11, hospital mortality was 31%, significantly lower than the proposed >90% threshold.
Conclusions:
- An initial SOFA score >11 is not associated with >90% hospital mortality and is therefore unreliable as a triage instrument for critical care.
- A small fraction of patients exhibit SOFA scores >20, which are associated with the highest mortality, limiting the broad applicability of SOFA for pandemic triage.
- Applying a SOFA >11 threshold during the H1N1 pandemic would have incorrectly excluded patients with substantially lower mortality rates.
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