Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Older patients in the ICU: a cautious analysis of epidemiologic data is required. | Fassier and Duclos Critical Care 2011 15 421 http content 15 2 421 CRITICAL CARE LETTER L_ Older patients in the ICU a cautious analysis of epidemiologic data is required Thomas Fassier and Antoine Duclos See related research by Roch etal. http content 15 1 R36 and related commentary by McDermid and Bagshaw http content 15 1 125 Recently published in Critical Care Roch and colleagues results have been extensively commented upon 1 2 . Indeed such observational studies are necessary to improve our understanding of ICU older patients outcome 2 . We plead for cautious analysis of these epidemiologic data however highlighting the following points. Available studies are scarce and are exposed to selection bias. In France the seven main cohort studies exploring octogenarian patients outcome so far published did not form a representative national sample 1-3 . Among the 42 participating centers 27 were medical ICUs and 27 were located in teaching hospitals moreover the heterogeneous case mix across centers impaired meaningful comparisons 1-3 . Most of these data were collected several years ago over huge periods of time - for example the French cohorts were enrolled from 1991 to 1996 and from 2001 to 2006 1-3 . The data were possibly biased by changes in practice occurring during this time such as changes in triage and care recently reported in cohorts of ICU older patients 3 4 . Finally cross-national comparisons are sensitive exposed to cultural biases. Local end-of-life policies and insurance policies can strongly influence ICU epidemiology. Between the UK and the USA for example the ICU admission rate varies from to 11 among the older patients dying in hospital 5 . In order to improve the admission decision-making process for ICU older patients we call for large multicenter cohort studies followed over time to obtain an accurate and updated picture of this nuanced and changing epidemiology. If we are to develop prognostic .
