title: Development and evaluation of an influenza pandemic intensive care unit triage protocol.
abstract: OBJECTIVE
  To develop an influenza pandemic ICU triage (iPIT) protocol that excludes patients with the highest and lowest predicted mortality rates, and to determine the increase in ICU bed availability that would result.
  
  
  METHODS
  Post-hoc analysis of a study evaluating two triage protocols, designed to determine which patients should be excluded from access to ICU resources during an influenza pandemic. ICU mortality rates were determined for the individual triage criteria in the protocols and included criteria based on the Sequential Organ Failure Assessment (SOFA) score. Criteria resulting in mortality rates outside the 25th and 75th percentiles were used as exclusion criteria in a new iPIT-1 protocol. The SOFA threshold component was modified further and reported as iPIT-2 and iPIT-3.
  
  
  METHODS
  Increase in ICU bed availability.
  
  
  RESULTS
  The 25th and 75th percentiles for ICU mortality were 8.3% and 35.2%, respectively. Applying the iPIT-1 protocol resulted in an increase in ICU bed availability at admission of 71.7% ± 0.6%. Decreasing the lower SOFA score exclusion criteria to ≤6 (iPIT-2) and ≤4 (iPIT-3) resulted in an increase in ICU bed availability at admission of 66.9% ± 0.6% and 59.4 ± 0.7%, respectively (P < 0.001).
  
  
  CONCLUSIONS
  The iPIT protocol excludes patients with the lowest and highest ICU mortality, and provides increases in ICU bed availability. Adjusting the lower SOFA score exclusion limit provides a method of escalation or de- escalation to cope with demand.
authors.affiliation: Concord Repatriation General Hospital, Sydney, NSW, Australia. winston.cheung@sswahs.nsw.gov.au.
authors.forename: Winston
authors.initials: W
authors.lastname: Cheung
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.forename: Ian M
authors.initials: IM
authors.lastname: Seppelt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Parr
authors.forename: Nikki
authors.initials: N
authors.lastname: Blackwell
authors.forename: Shannon
authors.initials: S
authors.lastname: Demonte
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Gandhi
authors.forename: Larissa
authors.initials: L
authors.lastname: Hoyling
authors.forename: Priya
authors.initials: P
authors.lastname: Nair
authors.forename: Melissa
authors.initials: M
authors.lastname: Passer
authors.forename: Claire
authors.initials: C
authors.lastname: Reynolds
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Saunders
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Saxena
authors.forename: Govindasamy
authors.initials: G
authors.lastname: Thanakrishnan
mesh_terms: D002985:Clinical Protocols; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality; D007362:Intensive Care Units; D009517:New South Wales; D009864:Ontario; D058873:Pandemics; D014218:Triage