title: The Eldicus prospective, observational study of triage decision making in European intensive care units: part I--European Intensive Care Admission Triage Scores.
abstract: OBJECTIVE
  Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage decision rule based on 28-day mortality rates of admitted and refused patients.
  
  
  METHODS
  Prospective, observational study of triage decisions from September 2003 until March 2005.
  
  
  METHODS
  Eleven intensive care units in seven European countries.
  
  
  METHODS
  All patients >18 yrs with a request for intensive care unit admission.
  
  
  METHODS
  Admission or rejection to an intensive care unit.
  
  
  RESULTS
  Clinical, laboratory, and physiological variables and data from severity scores were collected. Separate scores for accepted and rejected patients with 28-day mortality end point were built. Values for variables were grouped into categories determined by the locally weighted least squares graphical method applied to the logit of the mortality and by univariate logistic regressions for reducing candidates for the score. Multivariate logistic regression was used to construct the final score. Cutoff values for 99.5% specificity were determined. Of 6796 patients, 5602 were admitted and 1194 rejected. The initial refusal score included age, diagnosis, systolic blood pressure, pulse, respirations, creatinine, bilirubin, PaO2, bicarbonate, albumin, use of vasopressors, Glasgow Coma Scale score, Karnofsky Scale, operative status and chronic disorder, and the initial refusal receiver operating characteristics were area under the curve 0.77 (95% confidence interval 0.76-0.79). The final triage score included age, diagnosis, creatinine, white blood cells, platelets, albumin, use of vasopressors, Glasgow Coma Scale score, Karnofsky Scale, operative status and chronic disorder, and the final score receiver operating characteristics were area under the curve 0.83 (95% confidence interval 0.80-0.86). Patients with initial refusal scores >173.5 or final triage scores = 0 should be rejected.
  
  
  CONCLUSIONS
  The initial refusal score and final triage score provide objective data for rejecting patients that will die even if admitted to the intensive care unit and survive if refused intensive care unit admission.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. charles.sprung@ekmd.huji.ac.il
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.forename: Mario
authors.initials: M
authors.lastname: Baras
authors.forename: Gaetano
authors.initials: G
authors.lastname: Iapichino
authors.forename: Jozef
authors.initials: J
authors.lastname: Kesecioglu
authors.forename: Anne
authors.initials: A
authors.lastname: Lippert
authors.forename: Chris
authors.initials: C
authors.lastname: Hargreaves
authors.forename: Angelo
authors.initials: A
authors.lastname: Pezzi
authors.forename: Romain
authors.initials: R
authors.lastname: Pirracchio
authors.forename: David L
authors.initials: DL
authors.lastname: Edbrooke
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.forename: Jan
authors.initials: J
authors.lastname: Bakker
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gurman
authors.forename: Simon L
authors.initials: SL
authors.lastname: Cohen
authors.forename: Joergen
authors.initials: J
authors.lastname: Wiis
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data