ArticleCritical care (London, England)2016
Development of an algorithm to aid triage decisions for intensive care unit admission: a clinical vignette and retrospective cohort study.
Article in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Practices in Triage and Transfer of Critically Ill Patients: A Qualitative Systematic Review of Selection Criteria.Critical care medicine · 2020Pooled it
- Impact of nonclinical factors on intensive care unit admission decisions: a vignette-based randomized trial (V-TRIAGE).Revista Brasileira de terapia intensivaTrial
- Characteristics and Outcomes of Patients Referred but Declined for ICU Admission in a Resource-Limited Setting in South Africa.Critical care explorations · 2026Article
- Proposed intensive care unit triage models lack predictive validity for hospital mortality to deal with catastrophes: insights from a cohort study.Critical care science · 2026Article
- Priority setting in critical care: a multicriteria approach to ranking access to Intensive Care Unit beds.BMC health services research · 2025Article
- Prioritising deteriorating patients using time-to-event analysis: prediction model development and internal-external validation.Critical care (London, England) · 2024Article
- Safety and Effectiveness of Intensive Treatments Administered Outside the Intensive Care Unit to Hematological Critically Ill Patients: An Intensive Care without Walls Trial.Journal of clinical medicine · 2023Article
- Optimal age- and sex-based management of the queue to ventilators during the Covid-19 crisis.Journal of mathematical economics · 2021Article
- Identifying ICU admission decision patterns in a '20-questions game' approach using network analysis.The Southern African journal of critical care : the official journal of the Critical Care Society · 2021Article
- Evaluating Pediatric Sepsis Definitions Designed for Electronic Health Record Extraction and Multicenter Quality Improvement.Critical care medicine · 2020Observational
- Decision-making in the ICU: An analysis of the ICU admission decision-making process using a '20 Questions' approach.The Southern African journal of critical care : the official journal of the Critical Care Society · 2020Article
- Predicting the Need for Surgical Intervention Prior to First Encounter for Individuals With Knee Complaints: A Novel Approach.Orthopaedic journal of sports medicine · 2019Article
- The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri).The Southern African journal of critical care : the official journal of the Critical Care Society · 2019Article
- The Critical Care Society of Southern Africa Consensus Guideline on ICU Triage and Rationing (ConICTri).The Southern African journal of critical care : the official journal of the Critical Care Society · 2019Article
- ICU physicians' and internists' survival predictions for patients evaluated for admission to the intensive care unit.Annals of intensive care · 2018Article
- Prompt admission to the ICU: an instrument to improve mortality for deteriorating ward patients.Intensive care medicine · 2018Article
- Intermediate care to intensive care triage: A quality improvement project to reduce mortality.Journal of critical care · 2017Article
- The Influential Factor Analysis of Classification Partition Management Mode on the Emergency Triage.Iranian journal of public health · 2016Article
- Use of intensive care unit priority model in directing intensive care unit admission in Sudan: A prospective cross-sectional study.International journal of critical illness and injury scienceArticle
- Accountability for reasonableness and criteria for admission, triage and discharge in intensive care units: an analysis of current ethical recommendations.Revista Brasileira de terapia intensivaArticle
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntensive care unit (ICU) admission triage is performed routinely and is often based solely on clinical judgment, which could mask biases. A computerized algorithm to aid ICU triage decisions was developed to classify patients into the Society of Critical Care Medicine's prioritization system. In this study, we sought to evaluate the reliability and validity of this algorithm.
methodsNine senior physicians evaluated forty clinical vignettes based on real patients. The reference standard was defined as the priorities ascribed by two investigators with full access to patients' records. Agreement of algorithm-based priorities with the reference standard and with intuitive priorities provided by the physicians were evaluated. Correlations between algorithm prioritization and physicians' judgment of the appropriateness of ICU admissions in scarcity and nonscarcity settings were also evaluated. Validity was further assessed by retrospectively applying this algorithm to 603 patients with requests for ICU admission for association with clinical outcomes.
resultsAgreement between algorithm-based priorities and the reference standard was substantial, with a median κ of 0.72 (interquartile range [IQR] 0.52-0.77). Algorithm-based priorities demonstrated higher interrater reliability (overall κ 0.61, 95% confidence interval [CI] 0.57-0.65; median percentage agreement 0.64, IQR 0.59-0.70) than physicians' intuitive prioritization (overall κ 0.51, 95% CI 0.47-0.55; median percentage agreement 0.49, IQR 0.44-0.56) (p = 0.001). Algorithm-based priorities were also associated with physicians' judgment of appropriateness of ICU admission (priorities 1, 2, 3, and 4 vignettes would be admitted to the last ICU bed in 83.7%, 61.2%, 45.2%, and 16.8% of the scenarios, respectively; p < 0.001) and with actual ICU admission, palliative care consultation, and hospital mortality in the retrospective cohort.
conclusionsThis ICU admission triage algorithm demonstrated good reliability and validity. However, more studies are needed to evaluate a difference in benefit of ICU admission justifying the admission of one priority stratum over the others.
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