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What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?
- Andrew A. Quartin, MD, MPH;
- Roland M.H. Schein, MD; and
- Cynthia M. Cely, MD
- From University of Miami Miller School of Medicine, Miami, FL 33136.
TO THE EDITOR:
Levy and colleagues (1) retrospectively analyzed the Project IMPACT intensive care unit (ICU) database. They report that intensivist management was associated with increased mortality, despite adjustment for severity of illness and propensity for intensivist management. As Levy and colleagues acknowledge, their counterintuitive results contradict results of previous studies. We suspect that inadequate adjustment for confounding factors underlies these findings.
Most ICU severity models, including SAPS II and MPM0-II, were derived from populations with higher mortality than that of those from Project IMPACT. Without recalibration, these models exaggerate risk …
