Decision Modeler Report

COVID19 Triage to ICU Brigham Womens

Published: 4/14/2020

By: John Svirbely MD

Table of Contents

COVID19 Triage to ICU Brigham Womens

Overview

Triage to ICU

Decision Requirement Diagram

Elements

COVID19 Triage to ICU Brigham Womens

Overview

A patient with COVID19 should be triaged for ICU admission early if certain findings are present.

Triage to ICU

Decision Requirement Diagram

Elements

Should the ICU triage team be consulted? (Decision)

Decision Logic (Decision Table)

Should the ICU triage team be consulted?

F

Number of reasons to consider early triage

Should the ICU triage team be consulted?

Description

"No", "Yes"

1

0

"No"

2

>=1

"Yes"


References (Knowledge Source)

Description

Brigham and Women's Hospital COVID-19 Critical Care Clinical Guidelines. covidprotocols.org

Attachment

Brigham and Women's Hospital COVID-19 Critical Care Clinical Guidelines.

Number of reasons to consider early triage (Decision)

Decision Logic (Decision Table)

Number of reasons to consider early triage

C+

Does patient have severe comorbid disease?

Does the patient need intensive nursing care?-

Does the patient need multiple lab draws from an arterial line?

Is the patient at high risk for deterioration?

Is the provider concerned?

Number of findings indicating acidosis

Number of findings indicating hemodynamic instability

Number of findings indicating respiratory distress

Number of reasons to consider early triage

Description

1

false

-

-

-

-

-

-

-

0

2

true

-

-

-

-

-

-

-

1

3

-

false

-

-

-

-

-

-

0

4

-

true

-

-

-

-

-

-

1

5

-

-

false

-

-

-

-

-

0

6

-

-

true

-

-

-

-

-

1

7

-

-

-

false

-

-

-

-

0

8

-

-

-

true

-

-

-

-

1

9

-

-

-

-

false

-

-

-

0

10

-

-

-

-

true

-

-

-

1

11

-

-

-

-

-

0

-

-

0

12

-

-

-

-

-

>=1

-

-

1

13

-

-

-

-

-

-

0

-

0

14

-

-

-

-

-

-

>=1

-

1

15

-

-

-

-

-

-

-

0

0

16

-

-

-

-

-

-

-

>=1

1


Is the provider concerned? (Input Data)

Number of findings indicating respiratory distress (Decision)

Decision Logic (Decision Table)

Number of findings indicating respiratory distress

C+

Does the patient show significant work of breathing?

Has there been a rapid escalation of oxygen requirement?

Oxygen delivery in liters per minute to maintain oxygenation

Number of findings indicating respiratory distress

Description

[0..50]

1

false

-

-

0

2

true

-

-

1

3

-

false

-

0

4

-

true

-

1

5

-

-

<=6

0

6

-

-

>6

1


Does the patient need intensive nursing care? (Input Data)

Does the patient need multiple lab draws from an arterial line? (Input Data)

Number of findings indicating acidosis (Decision)

Decision Logic (Decision Table)

Number of findings indicating acidosis

C+

Arterial pH

Arterial PCO2 in mm Hg

Serum lactate in mmol per L

Is arterial PCO2 above the patient baseline?

Number of findings indicating acidosis

Description

[6.0..8.5]
[5..110]
[0..100]

1

<7.3

-

-

-

1

2

>=7.3

-

-

-

0

3

-

<=50

-

-

0

4

-

>50

-

-

1

5

-

-

<2

-

0

6

-

-

>=2

-

1

7

-

-

-

false

0

8

-

-

-

true

1


Is the patient at high risk for deterioration? (Input Data)

Does patient have severe comorbid disease? (Input Data)

Number of findings indicating hemodynamic instability (Decision)

Decision Logic (Decision Table)

Number of findings indicating hemodynamic instability

C+

Heart rate in beats per minute

Systolic blood pressure in mm Hg

Mean arterial pressure in mm Hg

Number of findings indicating hemodynamic instability

Description

[0..400]
[0..300)

1

<=120

-

-

0

2

>120

-

-

1

3

-

<90

-

1

4

-

>=90

-

0

5

-

-

<65

1

6

-

-

>=65

0


Mean arterial pressure in mm Hg (Decision)

Decision Logic (Literal Expression)

Mean arterial pressure in mm Hg

(Systolic blood pressure in mm Hg+(2*Diastolic blood pressure in mm Hg))/3


Oxygen delivery in liters per minute to maintain oxygenation (Input Data)

Description

Maintenance of oxygenation is oxygen saturation > 92% or PaO2 > 65 mm Hg.

Has there been a rapid escalation of oxygen requirement? (Input Data)

Does the patient show significant work of breathing? (Input Data)

Arterial pH (Input Data)

Arterial PCO2 in mm Hg (Input Data)

Is arterial PCO2 above the patient baseline? (Input Data)

Serum lactate in mmol per L (Input Data)

Diastolic blood pressure in mm Hg (Input Data)

Systolic blood pressure in mm Hg (Input Data)

Heart rate in beats per minute (Input Data)