Comparison of the 'Open' vs 'Closed' Intensive Care Unit Formats-Reply

Shannon S. Carson, MD; Carol Stocking, PhD; Jesse Hall, MD
JAMA. 1996;276(21):1721-1722. doi:10.1001/jama.1996.03540210029021.
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In Reply.  —Drs Bihari and Wittig question our conclusion that clinical outcome improved after changing from an open to a closed ICU format because we did not provide CIs for the SMRs. We compared the outcome of our patients with expected outcomes, based on a prediction equation provided by the APACHE II system. To provide CIs for the SMR in a given group, we would need an assessment of the actual APACHE II database to calculate standard error for predicted mortality. This was not at our disposal. Nonetheless, we stand by our conclusion that clinical outcome was improved in the closed ICU, based on comparison of mortality in each ICU format to a validated standard. Dr Alberts advocates comparison of observed mortality only, but this would not be useful because there were definite differences in illness severity between the 2 groups.Drs Alberts and Bihari raise concerns about bias in data collection


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