Association between critical care physician management and patient mortality in the intensive care unit.
BACKGROUND
Critically ill patients admitted to intensive care units (ICUs) are thought to gain an added survival benefit from management by critical care physicians, but evidence of this benefit is scant.


OBJECTIVE
To examine the association between hospital mortality in critically ill patients and management by critical care physicians.


METHODS
Retrospective analysis of a large, prospectively collected database of critically ill patients.


METHODS
123 ICUs in 100 U.S. hospitals.


METHODS
101,832 critically ill adults.


METHODS
Through use of a random-effects logistic regression, investigators compared hospital mortality between patients cared for entirely by critical care physicians and patients cared for entirely by non-critical care physicians. An expanded Simplified Acute Physiology Score was used to adjust for severity of illness, and a propensity score was used to adjust for differences in the probability of selective referral of patients to critical care physicians.


RESULTS
Patients who received critical care management (CCM) were generally sicker, received more procedures, and had higher hospital mortality rates than those who did not receive CCM. After adjustment for severity of illness and propensity score, hospital mortality rates were higher for patients who received CCM than for those who did not. The difference in adjusted hospital mortality rates was less for patients who were sicker and who were predicted by propensity score to receive CCM.


CONCLUSIONS
Residual confounders for illness severity and selection biases for CCM might exist that were inadequately assessed or recognized.


CONCLUSIONS
In a large sample of ICU patients in the United States, the odds of hospital mortality were higher for patients managed by critical care physicians than those who were not. Additional studies are needed to further evaluate these results and clarify the mechanisms by which they might occur.
Brown University, Providence, Rhode Island, USA. Mitchell_Levy@brown.edu
Mitchell M
MM
Levy
John
J
Rapoport
Stanley
S
Lemeshow
Donald B
DB
Chalfin
Gary
G
Phillips
Marion
M
Danis
D000328:Adult; D015986:Confounding Factors, Epidemiologic; D003422:Critical Care / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D010348:Patient Care Team / Q000592:standards; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States