Ethical Conflicts Associated with COVID-19 Pandemic, Triage and Frailty-unexpected Positive Disease Progression in a 90-year-old Patient: A Case Report

Overview

Journal Clin Case Rep

Date 2023 Jul 21

PMID 37476601

Authors

Andreas Wehrfritz

Joachim Schmidt

Frank Bremer

Anne-Katharina Lang

Jacob Welzer

Ixchel Castellanos

Affiliations

Soon will be listed here.

Abstract

During the COVID 19 pandemic, advanced age, scoring systems, and a shortage of ICU beds were used as cut-offs for ICU admission. This case report describes the epicrisis of an elderly patient who was almost mistakenly not treated in an ICU.

Citing Articles

Severity Patterns in COVID-19 Hospitalised Patients in Spain: I-MOVE-COVID-19 Study.

Latorre-Millan M, Rodriguez Del Aguila M, Clusa L, Mazagatos C, Larrauri A, Fernandez M Viruses. 2024; 16(11).

PMID: 39599820 PMC: 11598861. DOI: 10.3390/v16111705.

Ethical conflicts associated with COVID-19 pandemic, triage and frailty-unexpected positive disease progression in a 90-year-old patient: A case report.

Wehrfritz A, Schmidt J, Bremer F, Lang A, Welzer J, Castellanos I Clin Case Rep. 2023; 11(7):e7710.

PMID: 37476601 PMC: 10354352. DOI: 10.1002/ccr3.7710.

References

Heyland D, Barwich D, Pichora D, Dodek P, Lamontagne F, You J . Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med. 2013; 173(9):778-87. DOI: 10.1001/jamainternmed.2013.180. View

Michels G, Sieber C, Marx G, Roller-Wirnsberger R, Joannidis M, Muller-Werdan U . [Geriatric intensive care : Consensus paper of DGIIN, DIVI, DGAI, DGGG, ÖGGG, ÖGIAIN, DGP, DGEM, DGD, DGNI, DGIM, DGKliPha and DGG]. Z Gerontol Geriatr. 2019; 52(5):440-456. DOI: 10.1007/s00391-019-01584-6. View

Welch C . Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing. 2021; 50(3):617-630. PMC: 7929433. DOI: 10.1093/ageing/afab026. View

Garrouste-Orgeas M, Timsit J, Montuclard L, Colvez A, Gattolliat O, Philippart F . Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med. 2006; 32(7):1045-51. DOI: 10.1007/s00134-006-0169-7. View

Truog R, Mitchell C, Daley G . The Toughest Triage - Allocating Ventilators in a Pandemic. N Engl J Med. 2020; 382(21):1973-1975. DOI: 10.1056/NEJMp2005689. View

Bassford C . Decisions regarding admission to the ICU and international initiatives to improve the decision-making process. Crit Care. 2017; 21(1):174. PMC: 5500948. DOI: 10.1186/s13054-017-1749-3. View

Graf J, Wagner J, Graf C, Koch K, Janssens U . Five-year survival, quality of life, and individual costs of 303 consecutive medical intensive care patients--a cost-utility analysis. Crit Care Med. 2005; 33(3):547-55. DOI: 10.1097/01.ccm.0000155990.35290.03. View

Covinsky K, Fuller J, Yaffe K, Johnston C, Hamel M, Lynn J . Communication and decision-making in seriously ill patients: findings of the SUPPORT project. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc. 2000; 48(S1):S187-93. DOI: 10.1111/j.1532-5415.2000.tb03131.x. View

White D, Lo B . A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. 2020; 323(18):1773-1774. DOI: 10.1001/jama.2020.5046. View

10.

Wehrfritz A, Schmidt J, Bremer F, Lang A, Welzer J, Castellanos I . Ethical conflicts associated with COVID-19 pandemic, triage and frailty-unexpected positive disease progression in a 90-year-old patient: A case report. Clin Case Rep. 2023; 11(7):e7710. PMC: 10354352. DOI: 10.1002/ccr3.7710. View

11.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J . A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-733. PMC: 7092803. DOI: 10.1056/NEJMoa2001017. View

12.

Kojima G, Iliffe S, Walters K . Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing. 2017; 47(2):193-200. DOI: 10.1093/ageing/afx162. View

13.

Graf J, Koch M, Dujardin R, Kersten A, Janssens U . Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med. 2003; 31(8):2163-9. DOI: 10.1097/01.CCM.0000079607.87009.3A. View

14.

Emanuel E, Persad G, Upshur R, Thome B, Parker M, Glickman A . Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020; 382(21):2049-2055. DOI: 10.1056/NEJMsb2005114. View

15.

Zhang X, Jiao J, Cao J, Huo X, Zhu C, Wu X . Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis. BMC Geriatr. 2021; 21(1):186. PMC: 7968577. DOI: 10.1186/s12877-021-02138-5. View

16.

Pranata R, Henrina J, Lim M, Lawrensia S, Yonas E, Vania R . Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis. Arch Gerontol Geriatr. 2020; 93:104324. PMC: 7832565. DOI: 10.1016/j.archger.2020.104324. View

17.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. PMC: 7270627. DOI: 10.1016/S0140-6736(20)30566-3. View

18.

Hubbard R, Maier A, Hilmer S, Naganathan V, Etherton-Beer C, Rockwood K . Frailty in the face of COVID-19. Age Ageing. 2020; 49(4):499-500. PMC: 7239250. DOI: 10.1093/ageing/afaa095. View

19.

Heyland D, Cook D, Bagshaw S, Garland A, Stelfox H, Mehta S . The Very Elderly Admitted to ICU: A Quality Finish?. Crit Care Med. 2015; 43(7):1352-60. DOI: 10.1097/CCM.0000000000001024. View

20.

Flaatten H, de Lange D, Morandi A, Andersen F, Artigas A, Bertolini G . The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med. 2017; 43(12):1820-1828. DOI: 10.1007/s00134-017-4940-8. View