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What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?
- Constantine Manthous, MD; and
- Yaw Amoateng-Adjepong, MD, PhD
- From Bridgeport Hospital, Bridgeport, CT 06610.
TO THE EDITOR:
The study by Levy and colleagues (1) suggests that critically ill patients cared for by critical care physicians have a higher mortality rate than those cared for by nonspecialists. This observation challenges the science (2, 3) that has driven public policy for the past decade. Despite application of statistical methods to adjust for sicker patients in the treatment group, residual confounding may account for the observed result. Although the growing momentum of the critical care movement (3) may entice us to this conclusion, the findings of Levy and colleagues deserve very careful consideration. The implications for public health are substantial.
Let's assume the observed result is not due to error. The key exposure was whether the …
