Camilo R. Gomez, MD
To the editors: The article by Brook and colleagues (1) contains serious methodologic flaws that make some of the findings questionable and others reprehensible.
First, the outcome of the study is based on "appropriateness" of carotid endarterectomy. Nobody knows exactly for what patient, if any, this procedure is appropriate. The authors themselves recognize this in their introduction and yet analyze the data based on opinions expressed by consultants (2).
Second, the issue of "illness-severity" is problematic. It is unclear to what illness the authors are referring: isolated carotid artery disease? cerebrovascular atherosclerosis? ischemic brain disease? and, if so, hemodynamic? embolic?
Gomez CR. Outcomes of Carotid Endarterectomy. Ann Intern Med. ;114:703–704. doi: 10.7326/0003-4819-114-8-703_2
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Published: Ann Intern Med. 1991;114(8):703-704.
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