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February 26, 2003

Intensivist Consultation and Outcomes in Critically Ill Patients

JAMA. 2003;289(8):985-987. doi:10.1001/jama.289.8.985a

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.