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Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models.

Publication ,  Journal Article
Ashana, DC; Anesi, GL; Liu, VX; Escobar, GJ; Chesley, C; Eneanya, ND; Weissman, GE; Miller, WD; Harhay, MO; Halpern, SD
Published in: Am J Respir Crit Care Med
July 15, 2021

Rationale: Crisis standards of care (CSCs) guide critical care resource allocation during crises. Most recommend ranking patients on the basis of their expected in-hospital mortality using the Sequential Organ Failure Assessment (SOFA) score, but it is unknown how SOFA or other acuity scores perform among patients of different races. Objectives: To test the prognostic accuracy of the SOFA score and version 2 of the Laboratory-based Acute Physiology Score (LAPS2) among Black and white patients. Methods: We included Black and white patients admitted for sepsis or acute respiratory failure at 27 hospitals. We calculated the discrimination and calibration for in-hospital mortality of SOFA, LAPS2, and modified versions of each, including categorical SOFA groups recommended in a popular CSC and a SOFA score without creatinine to reduce the influence of race. Measurements and Main Results: Of 113,158 patients, 27,644 (24.4%) identified as Black. The LAPS2 demonstrated higher discrimination (area under the receiver operating characteristic curve [AUC], 0.76; 95% confidence interval [CI], 0.76-0.77) than the SOFA score (AUC, 0.68; 95% CI, 0.68-0.69). The LAPS2 was also better calibrated than the SOFA score, but both underestimated in-hospital mortality for white patients and overestimated in-hospital mortality for Black patients. Thus, in a simulation using observed mortality, 81.6% of Black patients were included in lower-priority CSC categories, and 9.4% of all Black patients were erroneously excluded from receiving the highest prioritization. The SOFA score without creatinine reduced racial miscalibration. Conclusions: Using SOFA in CSCs may lead to racial disparities in resource allocation. More equitable mortality prediction scores are needed.

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Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

July 15, 2021

Volume

204

Issue

2

Start / End Page

178 / 186

Location

United States

Related Subject Headings

  • White People
  • Sepsis
  • Retrospective Studies
  • Respiratory System
  • Respiratory Distress Syndrome
  • Race Factors
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Ashana, D. C., Anesi, G. L., Liu, V. X., Escobar, G. J., Chesley, C., Eneanya, N. D., … Halpern, S. D. (2021). Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models. Am J Respir Crit Care Med, 204(2), 178–186. https://doi.org/10.1164/rccm.202012-4383OC
Ashana, Deepshikha Charan, George L. Anesi, Vincent X. Liu, Gabriel J. Escobar, Christopher Chesley, Nwamaka D. Eneanya, Gary E. Weissman, William Dwight Miller, Michael O. Harhay, and Scott D. Halpern. “Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models.Am J Respir Crit Care Med 204, no. 2 (July 15, 2021): 178–86. https://doi.org/10.1164/rccm.202012-4383OC.
Ashana DC, Anesi GL, Liu VX, Escobar GJ, Chesley C, Eneanya ND, et al. Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models. Am J Respir Crit Care Med. 2021 Jul 15;204(2):178–86.
Ashana, Deepshikha Charan, et al. “Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models.Am J Respir Crit Care Med, vol. 204, no. 2, July 2021, pp. 178–86. Pubmed, doi:10.1164/rccm.202012-4383OC.
Ashana DC, Anesi GL, Liu VX, Escobar GJ, Chesley C, Eneanya ND, Weissman GE, Miller WD, Harhay MO, Halpern SD. Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models. Am J Respir Crit Care Med. 2021 Jul 15;204(2):178–186.

Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

July 15, 2021

Volume

204

Issue

2

Start / End Page

178 / 186

Location

United States

Related Subject Headings

  • White People
  • Sepsis
  • Retrospective Studies
  • Respiratory System
  • Respiratory Distress Syndrome
  • Race Factors
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Humans