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

De Nardo P, Gentilotti E, Mazzaferri F, Cremonini E, Hansen P, Goossens H, Tacconelli E; members of the COVID-19MCDA Group.

Int J Infect Dis. 2020 Sep;98:494-500. doi: 10.1016/j.ijid.2020.06.082. Epub 2020 Jun 30., 09/2020.

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.

Keywords: COVID-19; Multi-Criteria Decision Analysis; Pandemic; SARS CoV-2.

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