ArticleMedizinische Klinik, Intensivmedizin und Notfallmedizin2025
Evaluation of score-based tertiary triage policies during the COVID-19 pandemic: simulation study with real-world intensive care data.
Article in Medizinische Klinik, Intensivmedizin und Notfallmedizin, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Four-organ SOFA score as a potential tool to triage use of continuous kidney replacement therapy in COVID-19 patients with acute kidney injury: a retrospective two-center study.Renal failure · 2026Article
- [Anesthesiology as an integrative cross-sectional discipline of clinical resilience-What hospitals must anticipate now for high-load operations].Die Anaesthesiologie · 2026Review
- [What lessons can be learned from the debate on the German Triage Act?]Unfallchirurgie (Heidelberg, Germany) · 2026Article
- [First come, first failed : The rise and fall of Germany's Triage law].Die Anaesthesiologie · 2025Article
- [Medical decision-making in clinical disaster medicine and in healthcare crises : Applying ethics and law in resource allocation].Unfallchirurgie (Heidelberg, Germany) · 2025Article
- [German "Triage Act"-Regulation with fatal consequences].Die Anaesthesiologie · 2023Review
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Abstract
objectiveThe explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the "best for the most" patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of a tertiary triage of patients arises.
methodsWe provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in a COVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPS II), are compared based on the resulting mortality in the ICU and inferential statistics.
resultsOur study shows that score-based tertiary triage policies outperform non-score-based tertiary triage policies including compliance with the German Triage Act. Based on our simulation model, a SAPS II score-based tertiary triage policy reduces mortality in the ICU by up to 18 percentage points. The longer the queue of critical care patients waiting for ICU treatment and the larger the maximum number of patients subject to tertiary triage, the greater the effect on the reduction of mortality in the ICU.
conclusionA SAPS II score-based tertiary triage policy was superior in our simulation model. Random allocation or "first come, first served" policies yield the lowest survival rates, as will adherence to the new German Triage Act. An interdisciplinary discussion including an ethical and legal perspective is important for the social interpretation of our data-driven results.
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