The findings of the International Conference on Medical Emergency Teams are biased and misleading

Abstract

Intensive care unit treatment in patients >65 yrs with a first-day sequential organ failure assessment score >15 is not futile To the Editor:With great interest, we read the study by Kaarlola and colleagues (1), concerning long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. In their study, outcome and quality aspects were investigated in 882 patients older than 65 yrs. We were intrigued by their sentence under the Discussion that all patients in their study with a day-1 Sequential Organ Failure Assessment (SOFA) score Ͼ15 died in the intensive care unit (ICU). This seemed to differ from our experience. After a explorative database analysis of prospectively collected data, we found that in 13,989 consecutive patients admitted to our ICU, 7,984 patients were Ͼ65 yrs of age. Of these elderly patients, 131 had a day-1 SOFA score Ͼ15. The hospital mortality of these patients was 65 of 131. A hospital survival rate of 50% in those Ͼ65 yrs with a day-1 SOFA of Ͼ15 contrasts with the 100% mortality reported by Kaarlola et al.Under the Discussion, it is stated that a systematic bias toward overestimated quality-adjusted life years may exist if intensive care is withheld from elderly patients or selection in admission occurs and not all elderly patients are included in the analysis. It is possible, therefore, that the reported 100% mortality rate with day-1 SOFA score in patients Ͼ65 yrs could have been perceived as futile therapy, resulting in overestimated quality-adjusted life years. We agree with the authors that older age alone is not a valid reason to withhold intensive care; we disagree with their implicit statement that ICU treatment in patients Ͼ65 yrs with a first-day SOFA score Ͼ15 is futile.The authors have not disclosed any potential conflicts of interest. REFERENCE1. Kaarlola A, Tallgren M, Petillä V: Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients.

Effect of a Rapid Response Team on Patient Outcomes in a Community-Based Teaching Hospital

“…6 Other reviews showed similar conclusions. [16][17][18] One possible reason for the lack of effectiveness of the rapid response teams in our study could be the relative similarity in timeliness and quality of care for patients between the prerapid response and rapid response eras. The accessibility of residents when patients need to be seen remained constant, which may explain the lack of difference in mortality.…”

An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary referral intensive care unit after CPR

“…25 CCOS effectiveness therefore remains uncertain and debate continues with recent discussions focussing on both the benefits and cost effectiveness of outreach services. 26,27 Discussion of our results is therefore necessary to gauge their contribution to this debate. The second audit period (2006-09) was associated with significant reductions in cardiac arrest calls at FH plus reduced numbers and mortality of patients admitted to intensive care having undergone CPR.…”

“…Whilst clinicians rarely use this as an outcome measure, the matter is increasingly at the forefront of health-care planning and has been raised specific to critical care outreach. 26,27 This is therefore a consideration for future audit, where changes in outcomes within patient groups over time could be plotted and evaluated in both clinical and health economic contexts as changes in practise are introduced. 26,31 Thus in summary, our data showed significant improvements in overall hospital mortality rates, reductions in cardiac arrest calls, reductions in the proportion of patients having received in-hospital CPR prior to intensive care admission and improved hospitalsurvival of such patients.…”

Intensive care without walls – introduction of a Medical Emergency Team system in a Swiss tertiary care centre

“…To date, the effectiveness of RRS to improve patient outcomes remains a controversial matter. Studies have been limited, were not always adequately powered and have reported mixed results [20]. In the only multi-centre, cluster randomised study on the implementation of a RRS, investigators randomly assigned 12 hospitals to MET implementation and 11 to continued standard care including the on-going use of established cardiac arrest teams [21].…”