To the Editor: From their systematic review
of observational studies, Dr Pronovost and colleagues1 concluded
that intensive care units (ICUs) with mandatory intensivist consultation or
care had lower patient mortality and shorter length of stay than did ICUs
with either no intensivists or optional intensivist care. We are concerned,
however, that observational studies are easily biased (eg, selection, information,
and confounding bias), which can compromise internal validity.2 We
also are concerned that the authors chose to include only English-language
publications, thus excluding 294 articles with potentially relevant information.
García R, Tenias JM. Intensivist Consultation and Outcomes in Critically Ill Patients. JAMA. 2003;289(8):985–987. doi:10.1001/jama.289.8.985a
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