Paul Marik, MD; John Myburgh, PhD; Djillali Annane, MD, PhD; Jean-Louis Vincent, MD, PhD; Stephen Pastores, MD; G. Umberto Meduri, MD; Albertus Beishuizen, MD, PhD
Potential Financial Conflicts of Interest: None disclosed.
Marik P, Myburgh J, Annane D, Vincent J, Pastores S, Meduri GU, et al. What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?. Ann Intern Med. 2008;149:770-771. doi: 10.7326/0003-4819-149-10-200811180-00021
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Published: Ann Intern Med. 2008;149(10):770-771.
TO THE EDITOR:
We read the paper by Levy and colleagues (1) with much interest. We believe that the Project IMPACT database was not designed for (and is not capable of) answering the question posed. As such, the results are probably erroneous. The database demonstrates that sicker patients are more likely to be managed in larger academic hospitals by critical care physicians and are more likely to die (because they are sicker). The statistical manipulation of the data probably could not correct for this association. The critical reader should be extremely suspicious of any observational study using conglomerate propensity scores that assert associations, let alone causality, with outcomes. The paper by Connors and colleagues (2), which suggested that pulmonary artery catheters were associated with increased mortality, provides a key example of this point. Levy and colleagues suggest that critical care physicians are harmful; however, an analysis of their data would equally suggest that academic hospitals, as well as hospitals with primary fellowship training programs, are harmful.
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