Sequential Organ Failure Assessment in H1N1 pandemic planning*
Bibliographic record
Abstract
OBJECTIVE: The H1N1 pandemic has highlighted the importance of reliable and valid triage instruments. A Sequential Organ Failure Assessment score of >11 has been proposed to exclude patients from critical care resources quoting an associated mortality of >90%. We sought to assess the mortality associated with this Sequential Organ Failure Assessment threshold and the resource implications of such a triage protocol. DESIGN: Retrospective cohort. SETTING: Three multisystem intensive care units. PATIENTS: Consecutive patients admitted from January 2003 to December 2008. Subsequently, a comparison H1N1 cohort was assembled consisting of all patients admitted in 2009 with confirmed H1N1. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sequential Organ Failure Assessment was collected daily by use of an electronic bedside clinical information system (n = 10,204 patients, 69,913 patient days). Mean admission Acute Physiology and Chronic Health Evaluation was 19.1. 13.4% of the cohort (9% of total patient days) had an initial Sequential Organ Failure Assessment of >11. Mortality in patients with an initial Sequential Organ Failure Assessment score of >11 was 59% (95% confidence interval: 56%, 62%). The mortality associated with an initial Sequential Organ Failure Assessment >11 across diagnostic categories varied from 29% for poisoning to 67% for neurologic patients. Hospital mortality exceeded 90% only when initial Sequential Organ Failure Assessment was >20 (0.2% of patients). H1N1 patients were younger, had a longer intensive care unit length of stay, and more commonly had a respiratory admission diagnosis than the nonH1N1 cohort. Hospital mortality in H1N1 patients with an initial Sequential Organ Failure Assessment score of >11 was 31% (95% confidence interval: 5%, 56%). CONCLUSIONS: A Sequential Organ Failure Assessment score of >11 was not associated with a hospital mortality of >90% at any time during intensive care unit stay. Only a small proportion of patients have the extreme initial Sequential Organ Failure Assessment values associated with a hospital mortality of >90% limiting the usefulness of Sequential Organ Failure Assessment as a triage instrument for pandemic planning. Application of a Sequential Organ Failure Assessment threshold of >11 to the recent H1N1 pandemic would have excluded patients with a markedly lower mortality than seen in a large regional cohort of intensive care unit patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".