Triage of intensive care patients: identifying agreement and controversy.

Abstract

Intensive care unit (ICU) resources are limited in many hospitals. Patients with little likelihood of surviving are often admitted to ICUs. Others who might benefit from ICU are not admitted. To provide an updated consensus statement on the principles and recommendations for the triage of patients for ICU beds. The previous Society of Critical Care Medicine (SCCM) consensus statement was used to develop drafts of general and specific principles and recommendations. Investigators and consultants were sent the statements and responded with their agreement or disagreement. The Eldicus project (triage decision making for the elderly in European intensive care units). Eldicus investigators, consultants, and experts consisting of intensivists, users of ICU services, ethicists, administrators, and public policy officials. Consensus development was used to grade the statements and recommendations. Consensus was defined as 80% agreement or more. Consensus was obtained for 54 (87%) of 62 statements including all (19) general principles, 31 (86%) of the specific principles, and 10 (71%) of the recommendations. Inconsistencies in responses were noted for ICU admission and discharge. Despite agreement for guidelines applying to individual patients and an objective triage score, there was no agreement for a survival cutoff for triage, not even for a chance of survival of 0.1%. Consensus was reached for most general and specific ICU triage principles and recommendations. Further debate and discussion should help resolve the remaining discrepancies.