Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States

the STOP-COVID Investigators

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.

Original languageEnglish (US)
Article number100376
JournalCell Reports Medicine
Issue number9
StatePublished - Sep 21 2021
Externally publishedYes


  • ARDS
  • COVID-19
  • acute respiratory distress syndrome
  • crisis standards of care
  • critical care
  • intensive care
  • medical ethics
  • triage

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology


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