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Comment & Response
August 21, 2019

Addressing Limitations in Case-Control Study of Patients Undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta

Author Affiliations
  • 1Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
  • 2Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Surg. 2019;154(12):1167. doi:10.1001/jamasurg.2019.2744

To the Editor We read with great interest the article by Joseph et al.1 This is a 420-patient case-control study with propensity score matching that examines the value of resuscitative endovascular balloon occlusion of the aorta (REBOA). Patients undergoing REBOA were found to have worse outcomes than matched controls. However, the use of causal language surrounding the findings of the article—that REBOA use increases mortality risk—is unsupported. We posit that at least 2 biases regarding hospital confounding and time to surgery and selection bias for survivors draw this conclusion into question.

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