What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?
Authors: Constantine Manthous, Yaw Amoateng-Adjepong
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?Constantine Manthous, MD and Yaw Amoateng-Adjepong, MD, PhDConstantine Manthous, MDFrom Bridgeport Hospital, Bridgeport, CT 06610.Search for more papers by this author and Yaw Amoateng-Adjepong, MD, PhDFrom Bridgeport Hospital, Bridgeport, CT 06610.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-10-200811180-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The study by Levy and colleagues (1) suggests that critically ill patients cared for by critical care physicians have a higher mortality rate than those cared for by nonspecialists. This observation challenges the science (2, 3) that has driven public policy for the past decade. Despite application of statistical methods to adjust for sicker patients in the treatment group, residual confounding may account for the observed result. Although the growing momentum of the critical care movement (3) may entice us to this conclusion, the findings of Levy and colleagues deserve very careful consideration. The implications for public ...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. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, and Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151-62. [PMID: 12413375] CrossrefMedlineGoogle Scholar3. Manthous CA. Leapfrog and critical care: evidence- and reality-based intensive care for the 21st century. Am J Med. 2004;116:188-93. [PMID: 14749164] CrossrefMedlineGoogle Scholar4. Rubenfeld GD and Angus DC. Are intensivists safe? [Editorial]. Ann Intern Med. 2008;148:877-9 LinkGoogle Scholar5. Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, Jacob B, Alnuaimat HM, and Chatila W; Effects of a medical intensivist on patient care in a community teaching hospital. Mayo Clin Proc. 1997;72:391-9. [PMID: 9146680] CrossrefMedlineGoogle Scholar6. Pollack MM, Cuerdon TT, Patel KM, Ruttimann UE, Getson PR, and Levetown M. Impact of quality-of-care factors on pediatric intensive care unit mortality. JAMA. 1994;272:941-6. [PMID: 8084061] CrossrefMedlineGoogle Scholar7. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, and Katz JT; Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838-48. [PMID: 15509817] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Bridgeport Hospital, Bridgeport, CT 06610.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAre Intensivists Safe? Gordon D. Rubenfeld and Derek C. Angus Association between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit Mitchell M. Levy , John Rapoport , Stanley Lemeshow , Donald B. Chalfin , Gary Phillips , and Marion Danis What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Paul Marik , John Myburgh , Djillali Annane , Jean-Louis Vincent , Stephen Pastores , G. Umberto Meduri , and Albertus Beishuizen What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Marya D. Zilberberg and Andrew F. Shorr What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Mitchell M. Levy , John Rapoport , Stan Lemeshow , Gary Phillips , Donald B. Chalfin , and Marion Danis What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Tihomir Stefanec What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Joris J. Arends and Jan P. Vandenbroucke What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? William T. McGee What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Andrew A. Quartin , Roland M.H. Schein , and Cynthia M. Cely What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Michael Blumhardt What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Thomas L. Higgins , Brian Nathanson , and Daniel Teres Metrics November 18, 2008Volume 149, Issue 10Page: 770KeywordsCaregiversCritical careDeath ratesForecastingIntensive care unitsObservational studiesOutpatientsPalliative carePatientsPhysiciansPrevention, policy, and public healthPublic policySpecificityStatistical methods ePublished: 18 November 2008 Issue Published: November 18, 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...