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120 Abtahi et al. | Journal of Clinical and Translational Research 2024; 10(2): 119-140
severe acute respiratory syndrome coronavirus 2 (SARS- decision-making based on case severity and disease stage through
CoV-2) [1,2]. Most people infected with this virus experienced a systematic review and the opinions of clinicians.
mild to moderate respiratory diseases. Besides epidemiological
policies, patient-centric decision-making has been highly 2. Methods
crucial to control the COVID-19 pandemic. Particularly, at the This mixed-method study was conducted in two main phases,
pandemic peak, physicians had to make crucial decisions, based including a systematic review and a questionnaire-based survey
on widely recognized factors, for patient management within a for a panel of clinical experts. We employed a combination of
short time [3,4]. quantitative and qualitative analyses within the same study,
However, COVID-19 management is highly inconsistent enabling the exploration of diverse perspectives and relationships
due to symptom variations, ranging from mild to severe that exist between the complex layers of our multifaceted research
symptoms [5,6]. Therefore, the management of COVID-19 patients questions [26].
is a multi-criteria decision-making problem due to the complexities
of COVID-19 [7]. There are different decisions to be made for each 2.1. Research question
patient based on their condition [8]. These decisions could include This study was based on the following research question: What
referrals to the intensive care unit (ICU) or isolation at home. are the critical and essential factors for optimal decision-making
A COVID-19 patient may be assigned to a specific stage, typically and rapid management of COVID-19 cases based on disease
inclusive of discharge, ambulatory, inpatients, referral to the ICU, severity?
or death due to COVID-19 infection [9]. In these circumstances,
identifying the necessary factors can be significantly effective in 2.2. Systematic literature review
making the best decision.
Nonetheless, information is the key element for decision- 2.2.1. Search strategy
making, and decisions are made based on the most influential Articles from PubMed, Scopus, Web of Science, and IEEE
factors. Likewise, more data may not result in the best decision databases were searched from December 2019 to December
being made, but the most effective data provides the best care and 2022. The searched keywords included “triage,” “classification,”
safety for patients. Hence, we aim to identify the most fundamental “scoring system,” “forecasting,” “predict,” “prediction,”
factors for the best decision-making in COVID-19. In times of “ICU,” “critical care unit,” “severe acute respiratory syndrome
emergency, decision-making is critical, and the most influential coronavirus,” “COVID-19,” “SARS-CoV-2,” “2019 novel
factors result in the best decision-making [10]. In such situations, coronavirus,” “Wuhan coronavirus,” and “novel coronavirus.”
heuristic decision-making is adopted, whereby humans process The patient/population, intervention, comparison, and outcomes
information in a less complex way to reach better decisions model was used to define the search strategy [27]. This search
more efficiently. The heuristic approach can be more accurate for was restricted to English language papers. The search strategy is
complex problems and is one of the most important discoveries provided in Table A1.
of recent decades [11]. This type of decision-making is suitable
for COVID-19 as heuristics account for the uncertainty and risky 2.2.2. Inclusion criteria
conditions of COVID-19. Therefore, it is essential to prioritize
the effective factors, especially during an influx of patients. The The inclusion criteria were articles published in English and
priority of the factors should account for the patient’s condition focused on decision-making regarding COVID-19.
and the presently available evidence to ensure that clinical experts 2.2.3. Selection process
can make optimal, timely, and accurate decisions [12]. While
previous studies have determined the general factors affecting the Conference abstracts, letters to editors, papers with unavailable
status of COVID-19 patients [13-16], our study further identified full text, and papers with insufficient details about the data elements
the critical and essential factors for optimal decision-making (i.e., factors) were excluded from this review. This systematic
and rapid management of COVID-19 cases based on disease review was conducted based on the preferred reporting items for
severity. Recent studies have revealed that different approaches systematic reviews and meta-analyses (PRISMA) checklist [28].
were considered to manage and prioritize infected patients, 2.2.4. Data extraction
varying from home isolation to ICU admission [17,18]. Thus, the
effective factors regarding clinical decision-making and different After duplicate articles were removed, the article citations were
approaches to managing admitted patients can be divided into six imported to EndNote. In the first phase, all titles and abstracts of the
categories, comprised of (i) effective factors related to the length articles were independently examined by four authors based on our
of stay, (ii) effective factors related to ward referrals, (iii) effective main objective to select relevant studies. Another author reviewed
factors related to home referrals or home isolation, (iv) effective a sample of studies at random to validate the process. Next, all of
factors related to deterioration diagnosis, (v) effective factors the articles were categorized into six main categories, i.e., decision-
related to identifying the discharge time, and (vi) effective factors making for patient ward referrals, patient ICU referrals at the
related to ICU referrals [19-25]. Thus, the main objective of golden time, length of stay in the inward and/or the ICU, patient
our study was to determine the essential and critical factors for deterioration diagnosis, and patient discharge. These categories
DOI: https://doi.org/10.36922/jctr.22.00226