What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?
Authors: Joris J. Arends, Jan P. Vandenbroucke
Journal: Annals of Internal Medicine (2008)

LettersNovember 18, 2008What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?Joris J. Arends, MD and Jan P. Vandenbroucke, MD, PhDJoris J. Arends, MDFrom Leiden University Medical Center, Leiden 2300 RC, Netherlands.Search for more papers by this author and Jan P. Vandenbroucke, MD, PhDFrom Leiden University Medical Center, Leiden 2300 RC, Netherlands.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-10-200811180-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Levy and colleagues' (1) conclusion that CCM of critically ill patients is dangerous is premature. The authors state that the results are unexpected and completely contrary to previous findings. The best explanation of these results is the study's design, which allows clustering of confounders of mortality that cannot be adjusted by any standard risk-adjustment method (2). Because the study uses few inclusion and exclusion criteria, not only do the patient characteristics in the no-choice (CCM) and choice (no CCM) groups differ substantially in important prognostic factors (for example, artificial ventilation), but also the treatment environment differs (for ...References1. Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, and Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med. 2008;148:801-9 LinkGoogle Scholar2. Stukel TA, Fisher ES, Wennberg DE, Alter DA, Gottlieb DJ, and Vermeulen MJ. Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA. 2007;297:278-85. [PMID: 17227979] CrossrefMedlineGoogle Scholar3. Sinuff T, Adhikari NK, Cook DJ, Schnemann HJ, Griffith LE, and Rocker G; Mortality predictions in the intensive care unit: comparing physicians with scoring systems. Crit Care Med. 2006;34:878-85. [PMID: 16505667] CrossrefMedlineGoogle Scholar4. Vandenbroucke JP. When are observational studies as credible as randomised trials? Lancet. 2004;363:1728-31. [PMID: 15158638] CrossrefMedlineGoogle Scholar5. Diringer MN and Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001;29:635-40. [PMID: 11373434] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Joris J. Arends, MD; Jan P. Vandenbroucke, MD, PhDAffiliations: From Leiden University Medical Center, Leiden 2300 RC, Netherlands.Disclosures: None disclosed. 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Higgins , Brian Nathanson , and Daniel Teres Metrics November 18, 2008Volume 149, Issue 10Page: 768-769KeywordsCaregiversDatabasesDeath ratesFallsHemorrhageIntensive care unitsPatients ePublished: 18 November 2008 Issue Published: November 18, 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...