A patient assessment protocol called SOFA, or sequential organ failure assessment, may disadvantage Black patients seeking emergency room care for COVID-19, research finds.
During the worst of the COVID-19 pandemic, overwhelmed doctors and nurses in some places have had to make agonizing decisions about which patients should receive scarce health care resources. Some hospitals have contemplated using a standard measurement to guide these decisions. But two new studies in the journal PLOS ONE suggest that SOFA could promote racial disparities in treatment outcomes.
Developed two decades ago to assess illness severity among patients with sepsis, SOFA was designed to help predict which patients have the best chances of survival. A patient with a high SOFA score, according to the protocol, has a lower chance for survival.
In one of the new studies, researchers find that Black patients with COVID-19 admitted to Yale New Haven Health System hospitals typically have higher SOFA scores than white patients do.
The other study shows that while Black patients admitted in the Yale New Haven Health System tended to have higher SOFA scores than those of other racial or ethnic groups, their mortality rate was about the same.
“If we adopt this protocol [SOFA], we could end up disproportionally steering resources away from Black patients and towards other groups,” says Benjamin Tolchin, director of Yale New Haven Health’s Center for Clinical Ethics, and corresponding author of the second paper.
The Yale New Haven Health System is not using SOFA to guide patient care or inform allocation of resources. But other US hospitals have used the scores as a tool for rationing care during the recent surge in COVID-19 cases.
Since the earliest days of the pandemic, some health facilities have been forced to triage patients based on limited supplies. During the first wave of infections in the spring of 2020, some hospitals in northern Italy and New York City lacked the staff and equipment—such as ventilators and hemodialysis machines—needed to assist all emergency cases.
“What happened was that clinicians were making resource allocations decisions on a case-by-case basis, with some preference given to younger patients who were less likely to die from severe infection,” Tolchin says.
While some hospitals began contemplating the use of crisis standard protocols—including those that rely on criteria such as SOFA scores—these protocols had not been used until recently. In Idaho late this summer, for example, physicians were forced to ration medical care in response to the latest local surge in infections, adopting SOFA scores to guide these decisions.
Developed in 1996, the SOFA system calculates the mortality of patients based on the function of six organ systems.
“When we looked at this earlier this year, we were thinking of devising crisis standard of care recommendations that might be adopted in future pandemics,” Tolchin says. “We didn’t think we would be needing them so quickly.”
Source: Yale University