International Journal of Infectious Diseases (Sep 2020)

Multi-Criteria Decision Analysis to prioritize hospital admission of patients affected by COVID-19 in low-resource settings with hospital-bed shortage

  • Pasquale De Nardo,
  • Elisa Gentilotti,
  • Fulvia Mazzaferri,
  • Eleonora Cremonini,
  • Paul Hansen,
  • Herman Goossens,
  • Evelina Tacconelli,
  • E. Durante Mangoni,
  • L.L. Florio,
  • R. Zampino,
  • F. Mele,
  • I. Gentile,
  • B. Pinchera,
  • N. Coppola,
  • M. Pisaturo,
  • R. Luzzati,
  • N. Petrosillo,
  • E. Nicastri,
  • A. Corpolongo,
  • M.A. Cataldo,
  • A. D’Abramo,
  • G. Maffongelli,
  • L. Scorzolini,
  • C. Palazzolo,
  • E. Boumis,
  • A. Pan,
  • A. D’Arminio Monforte,
  • F. Bai,
  • S. Antinori,
  • F.G. De Rosa,
  • S. Corcione,
  • T. Lupia,
  • S.M. Pinna,
  • S. Scabini,
  • F. Canta,
  • S. Belloro,
  • Z. Bisoffi,
  • A. Angheben,
  • F. Gobbi,
  • E. Turcato,
  • N. Ronzoni,
  • L. Moro,
  • S. Calabria,
  • P. Rodari,
  • G. Bertoli,
  • G. Marasca,
  • M. Puoti,
  • A. Gori,
  • A. Bandera,
  • D. Mangioni,
  • M. Rizzi,
  • F. Castelli,
  • A. Montineri,
  • C.A. Coco,
  • M. Maresca,
  • M. Frasca,
  • D. Aquilini,
  • M. Vincenzi,
  • L. Lambertenghi,
  • M.E. De Rui,
  • E. Razzaboni,
  • P. Cattaneo,
  • A. Visentin,
  • A. Erbogasto,
  • I. Dalla Vecchia,
  • I. Coledan,
  • M. Vecchi,
  • G. Be,
  • L. Motta,
  • A. Zaffagnini,
  • N. Auerbach,
  • P. Del Bravo,
  • A.M. Azzini,
  • E. Righi,
  • E. Carrara,
  • A. Savoldi,
  • M. Sibani,
  • E. Lattuada,
  • G. Carolo,
  • M. Cordioli,
  • F. Soldani,
  • M.D. Pezzani,
  • S. Avallone,
  • R. Bruno,
  • A. Ricciardi,
  • M.P. Saggese,
  • G. Malerba

Journal volume & issue
Vol. 98
pp. 494 – 500

Abstract

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Objective: To use Multi-Criteria Decision Analysis (MCDA) to determine weights for eleven criteria in order to prioritize COVID-19 non-critical patients for admission to hospital in healthcare settings with limited resources. Methods: The MCDA was applied in two main steps: specification of criteria for prioritizing COVID-19 patients (and levels within each criterion); and determination of weights for the criteria based on experts’ knowledge and experience in managing COVID-19 patients, via an online survey. Criteria were selected based on available COVID-19 evidence with a focus on low- and middle-income countries (LMICs). Results: The most important criteria (mean weights, summing to 100%) are: PaO2 (16.3%); peripheral O2 saturation (15.9%); chest X-ray (14.1%); Modified Early Warning Score-MEWS (11.4%); respiratory rate (9.5%); comorbidities (6.5%); living with vulnerable people (6.4%); body mass index (5.6%); duration of symptoms before hospital evaluation (5.4%); CRP (5.1%); and age (3.8%). Conclusions: At the beginning of a new pandemic, when evidence for disease predictors is limited or unavailable and effective national contingency plans are difficult to establish, the MCDA prioritization model could play a pivotal role in improving the response of health systems.

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