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Robert G. Hart, MD; David G. Sherman, MD; Charles H. Tegeler, MD
University of Texas San Antonio

JAMA. 1985;254(9):1171.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Levy and colleagues¹ provide very helpful information about the prognosis of hypoxicischemic coma. While we fully agree that their data "provide a more rational approach for managing patients who sustain hypoxic-ischemic coma," we wonder about the possibility of a self-fulfilling prophecy that potentially confounds these data.

In this study, these investigators "refrained from any involvement in [the patients'] care." However, during the period of the study, it was the conventional wisdom that certain clinical features (eg, unreactive pupils) predicated poor recovery. If patients with a preconceived poor prognosis received less than maximal sustained supportive care, the outcome may have been influenced by these preconceptions. This potentially confounding factor is inevitable in a study in which all patients were not known to have received the same level of sustained care.

This is only a potential problem with these data, and of uncertain magnitude. The . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Senior Contributing Editor; Sharon Iverson, Assistant Editor.

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