Variability in triage practices for critically ill cancer patients: A randomized controlled trial

Area of Science:

• Critical Care Medicine
• Oncology
• Healthcare Management

Background:

• Intensive care unit (ICU) triage practices and provider interpretation of guidelines are understudied.
• Assessing agreement on patient prioritization for ICU admission is crucial for resource allocation.

Purpose of the Study:

• To evaluate provider agreement on ICU admission prioritization using different triage guidelines.
• To compare agreement levels between a general prioritization model and a cancer-specific flowchart.

Main Methods:

• A multi-centered randomized study involving 257 providers from 18 countries.
• Providers used clinical vignettes of oncological patients with either the Society of Critical Care Prioritization Model or a cancer-specific flowchart.
• Agreement was measured using entropy and Fleiss' kappa coefficients.

Main Results:

• Both the Prioritization Model and the cancer-specific flowchart showed similarly poor agreement among providers (average entropy 1.193 vs. 1.153; Fleiss' kappa 0.2136 vs. 0.2457).
• The findings indicate a low level of consensus regardless of the guideline used.

Conclusions:

• There is a significant lack of agreement among practitioners in prioritizing cancer patients for ICU admission, irrespective of guideline type.
• This consensus gap poses a potential barrier to equitable and appropriate resource allocation in oncology critical care.