Health equity and distributive justice considerations in critical care resource allocation

ARTICLE: Health equity and distributive justice considerations in critical care resource allocation

AUTHORS: Panagis GaliatsatosAllen Kachalia, Harolyn M E Belcher, Mark T Hughes, Jeffrey Kahn, Cynda H Rushton, Jose I Suarez, Lee Daugherty Biddison and Sherita H Golden

JOURNAL: Lancet Respir Med. 2020 Jun 22. doi: 10.1016/S2213-2600(20)30277-0 [Epub ahead of print]

Amid the possibility of resource shortages in health care during a public health crisis, guiding principles established by several groups advocate for allocating life-sustaining treatments on the basis of a patient's chances of survival, resulting in an approach of saving the most lives possible. To assist in this approach, many triage frameworks use acute illness scores to predict short-term mortality. The sequential organ failure assessment (SOFA) score has received attention as a mortality prediction tool during the COVID-19 pandemic and is likely to be used by hospitals in some manner as a triage tool. Although the SOFA score's use has been validated for a variety of purposes in studies done in dozens of countries, two clear limitations exist. First, there are insufficient data on how the SOFA score performs as a predictor of COVID-19 outcomes and on outcomes in specific populations based on features such as race and ethnicity. Second, even if the SOFA score predicts outcomes reliably, it is far from clear that using it as a tool for allocating critical care resources is fair. For example, in the context of sepsis, a syndrome caused by infections such as COVID-19, African Americans, compared with white people, have disproportionately greater incidence of sepsis and worse physiological effects upon sepsis presentation; therefore, SOFA scores might be unfavourably higher in African Americans during this pandemic.

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