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Editorials |

Critical Care Outcomes in the United Kingdom : Sobering Wake-up Call or Stability of the Lamppost?

Kenneth E. Wood, DO, FCCP; Douglas B. Coursin, MD, FCCP (Madison, WI); R. Michael Grounds, MD
Author and Funding Information

Affiliations: London, UK 
 ,  Dr. Wood is the Director of the Trauma and Life Support Center and the Assistant Professor of Internal Medicine; Dr. Coursin is the Associate Director of the Trauma and Life Support Center and the Professor of Anesthesiology and Internal Medicine, University of Wisconsin Hospitals and Clinics; and Dr. Grounds is the Consultant Anaesthetist/Intensivist at St. Georges Hospital.

Correspondence to: Douglas B. Coursin, MD, Professor of Anesthesiology and Internal Medicine, B6/319 UW CSC, Madison, WI 53792-3272; e-mail: dcoursin@facstaff.wisc.edu



Chest. 1999;115(3):614-616. doi:10.1378/chest.115.3.614
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Extract

It has been suggested that physicians should use statistics“ as the drunken man uses the lamppost—for support rather than illumination.”1 In this issue of CHEST (see page 802), Pappachan and colleagues report on their attempt to perform a validation study of APACHE III (acute physiology and chronic health evaluation) in 17 general adult ICUs in the South of England (hospital size range 300 to 800 beds). The significantly high standard mortality ratio (SMR = observed/predicted mortality ratio) in the UK hospitals raises the questions of whether a sobering wake-up call to a health-care system has been sounded or whether the statistical foundation upon which the lamppost is situated needs to be stabilized and reevaluated. Although the use of SMR as a measure of ICU performance is debatable,2,,3,,4,,5 the significant excess in mortality beyond the severity stratified predictions warrants close examination and explanation.


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