Newly Published
Correspondence  |   August 2019
Cardiac Events after Electroconvulsive Therapy: Reply
Author Notes
  • University of Chicago, Chicago, Illinois (P.N.). pnagele@dacc.uchicago.edu
  • (Accepted for publication June 7, 2019.)
    (Accepted for publication June 7, 2019.)×
Article Information
Correspondence
Correspondence   |   August 2019
Cardiac Events after Electroconvulsive Therapy: Reply
Anesthesiology Newly Published on August 19, 2019. doi:10.1097/ALN.0000000000002928
Anesthesiology Newly Published on August 19, 2019. doi:10.1097/ALN.0000000000002928
We appreciate Dr. Østergaard and Dr. Kellner’s comments on our article. The mortality rate in Tørring et al.1  was 2.1 deaths (95% CI, 1.2 to 3.4) per 100,000 electroconvulsive therapy treatments and 6.0 deaths (95% CI, 2.0 to 23.0) per 100,000 electroconvulsive therapy treatments in our meta-analysis.2  The difference may appear large; however, the 95% CIs overlap and thus, the two studies are less discrepant than they appear at first sight. Three primary reasons may explain the difference between the two studies. First, as pointed out by Østergaard and Kellner, there are statistical differences. Second, our study aimed at all-cause mortality to obtain an unbiased estimate of risk after electroconvulsive therapy. Trying to identify a causal relationship between electroconvulsive therapy and death from a retrospective review of the literature is difficult at best, and exposes the analysis to bias, which we wanted to avoid.3  Third, we included all studies regardless the sample size (Tørring et al. included only studies with a minimum of 3,000 electroconvulsive therapy treatments). We choose to include all studies to limit selection bias but accept the concern of a small study bias.