Disaster Medicine and Public Health Preparedness

Research Article

A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

Colin K. Grissom c1, Samuel M. Brown, Kathryn G. Kuttler, Jonathan P. Boltax, Jason Jones, Al R. Jephson and James F. Orme Jr

ABSTRACT

Objective: The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score.

Methods: After a retrospective derivation in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during the 2008 calendar year and compared the ability to predict mortality and the need for mechanical ventilation.

Results: A total of 1770 patients (56% male patients) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% confidence interval 0.81-.85) and 0.84 (95% confidence interval 0.82-.85), respectively (P = .33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the intensive care unit with an AUC of 0.78 and 0.79, respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted the need for mechanical ventilation on day 3, with an AUC of 0.83 and 0.82, respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58%, respectively.

Conclusions: The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.

(Disaster Med Public Health Preparedness. 2010;4:277-284)

(Received June 09 2010)

(Accepted October 01 2010)

Key Words:

  • intensive care unit, pandemic;
  • disaster;
  • multiple organ failure;
  • triage;
  • critical care;
  • mass casualty incidents;
  • prognosis

Correspondence

c1 Correspondence: Address correspondence and reprint requests to Dr Colin K. Grissom, Critical Care Medicine, Intermountain Medical Center, 5121 South Cottonwood St, Murray, UT 84107 (e-mail: colin.grissom@imail.org).

Author Affiliations: Drs Grissom, Brown, Kuttler, and Orme and Mr Jephson are with Intermountain Medical Center; Dr Boltax is with the Department of Medicine, Pulmonary and Critical Care Division, University of Utah; Dr Jones is with the Homer Warner Center for Informatics Research, Intermountain Healthcare.

This work was supported by the Heart and Lung Foundation and the Easton Family Fund of the Deseret Foundation, Intermountain Medical Center, Murray, Utah.