BMJ 2001;322:1261-1262 ( 26 May )

Editorials

Safer discharge from intensive care to hospital wards

Randomisation is necessary to disentangle intrinsic patient risk from effects of care

Papers p 1274

The first 150 words of the full text of this article appear below.

Intensive care in the United Kingdom is certainly underprovided relative to many developed counties. The United States spends over 1% of its gross national product on providing intensive care, while Britain spends around 0.05%---possibly twentyfold less.1 But intensive care remains largely outside the evidence based paradigm---apparently for ethical reasons. Judging the appropriateness of intensive care provision still depends solely on apparent unmet need and observed associations of prognostic indicators with mortality. This week's BMJ sees another such study.2

It seems too easy to claim benefit in intensive care on the basis of biological plausibility and observational comparison alone. For example, a recent Cochrane overview of 30 trials on the effect of intravenous albumin for acute renal failure,3 which showed significant harm, was dismissed by some enthusiasts.4 The writings of respected and dispassionate authors who have held intensive care to be immune from randomisation do not help this apparent impasse. 5 6 . . . [Full text of this article]
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Relevant Articles

Mortality after discharge from intensive care
Andrew Inglis, Richard Price, Julian Bion, Michael J O'Leary, and David J Bihari
BMJ 2001 323: 629. [Extract] [Full Text]

Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model
Kathleen Daly, R Beale, and R W S Chang
BMJ 2001 322: 1274. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

  • Goldhill, D.R. (2001). The critically ill: following your MEWS. QJM 94: 507-510 [Full text]  
  • Inglis, A., Price, R., Bion, J., O'Leary, M. J, Bihari, D. J (2001). Mortality after discharge from intensive care. BMJ 323: 629-629 [Full text]  

Rapid Responses:

Read all Rapid Responses

The evidence for intensive care
Michael J O'Leary
bmj.com, 29 May 2001 [Full text]
The ethics of randomisation in intensive care research
Julian Bion
bmj.com, 1 Jun 2001 [Full text]
Alternatives to evidence based medicine in neurosurgical ICU
Vincenzo Bonicalzi, et al.
bmj.com, 8 Jun 2001 [Full text]
Intensive Care Units are also Public Health facilities
A J P Schrijvers
bmj.com, 16 Sep 2001 [Full text]
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