What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?

LettersNovember 18, 2008What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?Paul Marik, MD, John Myburgh, PhD, Djillali Annane, MD, PhD, Jean-Louis Vincent, MD, PhD, Stephen Pastores, MD, G. Umberto Meduri, MD, and Albertus Beishuizen, MD, PhDPaul Marik, MDFrom Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Search for more papers by this author, John Myburgh, PhDFrom Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Search for more papers by this author, Djillali Annane, MD, PhDFrom Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Search for more papers by this author, Jean-Louis Vincent, MD, PhDFrom Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Search for more papers by this author, Stephen Pastores, MDFrom Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Search for more papers by this author, G. Umberto Meduri, MDFrom Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Search for more papers by this author, and Albertus Beishuizen, MD, PhDFrom Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-10-200811180-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...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. Connors AF, Speroff T, Dawson NV, Thomas C, Harrell FE, and Wagner D; The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996;276:889-97. [PMID: 8782638] CrossrefMedlineGoogle Scholar3. 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 Scholar4. Ghorra S, Reinert SE, Cioffi W, Buczko G, and Simms HH. Analysis of the effect of conversion from open to closed surgical intensive care unit. Ann Surg. 1999;229:163-71. [PMID: 10024095] CrossrefMedlineGoogle Scholar5. . Guidelines for the definition of an intensivist and the practice of critical care medicine. Guidelines Committee; Society of Critical Care Medicine. Crit Care Med. 1992;20:540-2. [PMID: 1559370] CrossrefMedlineGoogle Scholar6. Hogan AM and Winter DC. Does practice make perfect? Ann Surg Oncol. 2008;15:1267-70. [PMID: 18228105] CrossrefMedlineGoogle Scholar7. Billingsley KG, Morris AM, Dominitz JA, Matthews B, Dobie S, Barlow W, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007;142:23-31; discussion 32. [PMID: 17224497] Google Scholar8. Magid DJ, Calonge BN, Rumsfeld JS, Canto JG, Frederick PD, and Every NR; National Registry of Myocardial Infarction 2 and 3 Investigators. Relation between hospital primary angioplasty volume and mortality for patients with acute MI treated with primary angioplasty vs thrombolytic therapy. JAMA. 2000;284:3131-8. [PMID: 11135776] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Thomas Jefferson University, Philadelphia, PA 19107; St. George Hospital, Sydney, New South Wales 2217, Australia; Universit de Versailles Saint-Quentin en Yvelines, Hpital Raymond Poincar, Garches 92380, France; Erasme Hospital, Brussels 1070, Belgium; Memorial Sloan-Kettering Cancer Center, New York, NY 10065; University of Tennessee Health Science Center, Memphis TN 38163; and VU Medical Center, Amsterdam 1081, Netherlands.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation 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? Marya D. 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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: 770-771KeywordsAngioplastyCritical careDatabasesFellowshipsHealth care qualityIntensive care unitsObservational studiesPatientsPhysiciansPulmonary arteriesStatistical dataSub-specialty careSurgeons ePublished: 18 November 2008 Issue Published: November 18, 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...