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Comment & Response
July 12, 2016

Management of Community-Acquired Pneumonia—Reply

Author Affiliations
  • 1Division of General Internal Medicine, University of California, San Francisco
  • 2Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 3Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
JAMA. 2016;316(2):222-223. doi:10.1001/jama.2016.5028

In Reply Dr Paul and colleagues question our decision to exclude observational studies that did not perform statistical adjustment for illness severity or comorbidity when assessing the association between time to initiate antibiotic therapy and mortality. All studies meeting eligibility for this question were observational in design and had a high likelihood of confounding by indication (ie, patients who were more severely ill would be more likely to have antibiotic therapy initiated rapidly). Therefore, we considered it imperative to focus the review on studies with adjustment for such confounding.

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