Hitinder S. Gurm, MD; Carrie Hosman, PhD; Ben B. Hansen, PhD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0899.
Gurm HS, Hosman C, Hansen BB. Comparative Safety of Vascular Closure Devices. Ann Intern Med. 2014;160:438-439. doi: 10.7326/L14-5006-2
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Published: Ann Intern Med. 2014;160(6):438-439.
We agree with Drs. Shah and Khan that observational data alone can establish association but not causation. Because of the possibility of unmeasured confounding, such associations at best suggest a causal link. Although we take this to be widely understood, we nonetheless reaffirmed it in the abstract and body of our article. More important, we adjusted for a broad array of potential confounders, including several of those mentioned by Drs. Shah and Khan; analyzed the sensitivity of the adjusted association to hypothetical further adjustments for additional confounders; and presented results from an empirical evaluation of the completeness of the adjustment.
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