• Nisha K Rathi, Sajid A Haque, Freddy Morales, Bhavika Kaul, Rafael Ramirez, Steven Ovu, Lei Feng, Wenli Dong, Kristen J Price, Sebastian Ugarte, Nestor Raimondi, Agamenon Quintero, Yenny R Cardenas, Joseph L Nates, and LACCTIN and ONCCC-R-NET groups.
• Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America. Electronic address: nrathi@mdanderson.org.
• J Crit Care. 2019 Oct 1; 53: 18-24.

PurposeIntensive care triage practices and end-user interpretation of triage guidelines have rarely been assessed. We evaluated agreement between providers on the prioritization of patients for ICU admission using different triage guidelines.Materials And MethodsA multi-centered randomized study on providers from 18 different countries was conducted using clinical vignettes of oncological patients. The level of agreement between providers was measured using two different guidelines, with one being cancer specific.ResultsAmongst 257 providers, 52.5% randomly received the Society of Critical Care Prioritization Model, and 47.5% received a cancer specific flowchart as a guide. In the Prioritization Model arm the average entropy was 1.193, versus 1.153 in the flowchart arm (P = .095) indicating similarly poor agreement. The Fleiss' kappa coefficients were estimated to be 0.2136 for the SCCMPM arm and 0.2457 for the flowchart arm, also similarly implying poor agreement.ConclusionsThe low agreement amongst practitioners on the prioritization of cancer patient cases for ICU admission existed using both general triage guidelines and guidelines tailored only to cancer patients. The lack of consensus on intensive care unit triage practices in the oncological population exposes a potential barrier to appropriate resource allocation that needs to be addressed.Copyright © 2019 Elsevier Inc. All rights reserved.

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