On Where, and Whether, the Sex Difference Disappears: Denominators and Conditioning in the Timing of ICU Treatment-Limitation Decisions

Amacher and colleagues have assembled a dataset and posed exactly the right question: not merely whether women and men differ in how often life-sustaining therapy is curtailed, but when along the care pathway that divergence takes shape. Their headline finding is elegant in its symmetry. A pronounced female excess at admission (adjusted odds ratio ۱.۲۶, ۹۵% CI ۱.۲۴–۱.۲۸) gives way, they report, to parity once treatment is under way, the during-stay rates standing at “۵.۵% versus ۵.۵%.” From this they infer that decisions grow more even-handed as objective clinical information accrues. We admire the study but believe two linked problems undermine that inference. The first is arithmetical and present on the face of Table ۱; the second is structural and inheres in the staged design itself. Both deserve closer scrutiny than they have so far received.

کلیدواژه ها:

Sex Difference ، Intensive Care Unit ، Treatment-Limitation