Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 8 ( 2018 ) > List of Articles


Development a reverse triage system based on modified sequential organ failure assessment for increasing the critical care surge capacity

Hossein Ghasemian-Nik, Raheb Ghorbani

Keywords : Modified sequential organ failure, reverse triage, surge capacity

Citation Information : Ghasemian-Nik H, Ghorbani R. Development a reverse triage system based on modified sequential organ failure assessment for increasing the critical care surge capacity. Indian J Crit Care Med 2018; 22 (8):575-579.

DOI: 10.4103/ijccm.IJCCM_47_18

License: CC BY-ND 3.0

Published Online: 01-09-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Context: The capacity completeness are one of the serious problems in the bed's managements of the critical care units in a crisis and disaster situation. Reverse triage can help to hospital surge capacity in this situations. Aims: The aim of this study was to develop a reverse triage system based on Modified Sequential Organ Failure Assessment (MSOFA) for increasing critical care surge capacity. Settings and Design: This study was a prospective design that performed on the medical patients in critical care unit. Subjects and Methods: The MSOFA score for each patient was calculated in admission time and be continued until discharging time from critical care unit. Statistical Analysis Used: The Cox regression method was used to determine the relative risk values. At last, the patients were divided into three levels for reverse triage. Results: Four hundred and twenty patients were participated in this study. The mean of patients' MSOFA scores in the 1st day of admission in Critical Care was 5.40 ± 3.8. The relative risk of internal patients discharge from critical care was (8.2%). Death relative risks were <25%, higher than 70% and between 25.1% and 69.9% for three color level of green, black, and red, respectively. Conclusion: The MSOFA scores can contribute to the design a leveling system for discharging patients from critical care unit. Based on this system, the members of the caring team can predict the final health status of the patient.

PDF Share
  1. Kim SH, Chan CW, Olivares M, Escobar G. ICU admission control: An empirical study of capacity allocation and its implication for patient outcomes. Manag Sci 2014;61:19-38.
  2. Kelen GD, Kraus CK, McCarthy ML, Bass E, Hsu EB, Li G, et al. Inpatient disposition classification for the creation of hospital surge capacity: A multiphase study. Lancet 2006;368:1984-90.
  3. Watson SK, Rudge JW, Coker R. Health systems' “surge capacity”: State of the art and priorities for future research. Milbank Q 2013;91:78-122.
  4. Adams LM. Exploring the concept of surge capacity. Online J Issues Nurs 2009;14:1-12.
  5. Kearns RD, Cairns BA, Cairns CB. Surge capacity and capability. A review of the history and where the science is today regarding surge capacity during a mass casualty disaster. Front Public Health 2014;2:29.
  6. Bayram JD, Sauer LM, Catlett C, Levin S, Cole G, Kirsch TD, et al. Critical resources for hospital surge capacity: An expert consensus panel. PLoS Curr 2013;5. pii: ecurrents.dis. 67c1afe8d78ac2ab0ea52319eb119688.
  7. Kelen GD, McCarthy ML, Kraus CK, Ding R, Hsu EB, Li G, et al. Creation of surge capacity by early discharge of hospitalized patients at low risk for untoward events. Disaster Med Public Health Prep 2009;3:S10-6.
  8. Frolic A, Kata A, Kraus P. Development of a critical care triage protocol for pandemic influenza: Integrating ethics, evidence and effectiveness. Healthc Q 2009;12:54-62.
  9. Ebrahimian A, Fakhr-Movahedi A, Ghasemian-Nik H. Evaluation the mean alteration trends and validation of nine equivalents of nursing manpower use score in medical patients of Intensive Care Units. Koomesh 2017;19:458-65.
  10. Asad Zandi M, Karati T, Tadrisi SD, Ebadi A. Estimation of the mortality rate using the APACHE II standard disease severity scoring system in Intensive Care Unit patients. J Crit Care Nurs 2012;4:209-14.
  11. Schusterschitz N, Joannidis M. Predictive capacity of severity scoring systems in the ICU. Acute Kidney Injury. Contrib Nephrol. Basel, Karger, 2007. p. 92-100.
  12. Ebrahimian A, Masoumi G, Jamshidi-Orak R, Seyedin H. Development and psychometric evaluation of the pre-hospital medical emergencies early warning scale. Indian J Crit Care Med 2017;21:205-12.
  13. Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: A compendium. Indian J Crit Care Med 2014;18:220-8.
  14. Grissom CK, Brown SM, Kuttler KG, Boltax JP, Jones J, Jephson AR, et al. A modified sequential organ failure assessment score for critical care triage. Disaster Med Public Health Prep 2010;4:277-84.
  15. Christian MD, Hawryluck L, Wax RS, Cook T, Lazar NM, Herridge MS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ 2006;175:1377-81.
  16. Moreno R, Miranda DR, Matos R, Fevereiro T. Mortality after discharge from intensive care: The impact of organ system failure and nursing workload use at discharge. Intensive Care Med 2001;27:999-1004.
  17. Geoffrey RN, David LS. Biostatistics. 2nd ed. London: Hamilton; 2002.
  18. Babamohamadi H, Ebrahimian A, Paknazar F, Torkamandi H. Clinical effectiveness of modified sequential organ failure assessment scoring system for predicting ICU indexing scores. Tehran Univ Med J 2016;74:509-16.
  19. Sendagire C, Lipnick MS, Kizito S, Kruisselbrink R, Obua D, Ejoku J, et al. Feasibility of the modified sequential organ function assessment score in a resource-constrained setting: A prospective observational study. BMC Anesthesiol 2017;17:12.
  20. Halim DA, Murni TW, Redjeki IS. Comparisonof Apache II, SOFA, and modified SOFA scores in predicting mortality of surgical patients in intensive care unit at Dr. Hasan Sadikin General Hospital. Crit Care Shock 2009;12:157-69.
  21. Gholipour Baradari A, Sharifi H, Firouzian A, Daneshiyan M, Aarabi M, Talebiyan Kiakolaye Y, et al. Comparison of proposed modified and original sequential organ failure assessment scores in predicting ICU mortality: A prospective, observational, follow-up study. Scientifica (Cairo) 2016;2016:7379325.
  22. Namendys-Silva SA, González-Herrera MO, García-Guillén FJ, Texcocano-Becerra J, Herrera-Gómez A. Outcome of critically ill patients with hematological malignancies. Ann Hematol 2013;92:699-705.
  23. Robbins AS, Chao SY, Fonseca VP. What's the relative risk? A method to directly estimate risk ratios in cohort studies of common outcomes. Ann Epidemiol 2002;12:452-4.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.