“6 Orlando shooting victims remain ‘critically ill,’ another 5 patients in ‘guarded’ condition”
Even the trauma center, Orlando Health, tweeted this the other day:
“No surgeries on the victims are scheduled for today. 4 patients are in critical condition, 2 are guarded, and 12 are stable.”
I think we all have an idea of what critical and stable mean [more about this below], but what about guarded?
I’ve never known what guarded means and wondered if it was just me. To find out, I conducted an informal 24-hour Twitter poll.
Here are the results:
By a 2% margin, “I have no idea” was the most common response, but 35% thought guarded condition meant between serious and critical, and 21% thought guarded was better than serious.
Google “guarded condition,” and you will get thousands—maybe millions—of hits with stories of patients described as “guarded.”
As far back as 1990 and probably much further back than that, the term “guarded” was causing confusion. In a Baltimore Sun article, an intensivist said, "A nurse might choose to say guarded, knowing the patient is very sick but not knowing which way he will go." Of course, that could be said about many patients in intensive care.
The editor of the journal Chest, A. Jay Block, addressed the question in 1994: “What is ‘guarded condition’ anyway?” He noted that although ICU staff used the term, no one knew what it meant.
He didn’t know either and suggested it shouldn’t be used.
The American Hospital Association has issued guidelines on the subject of patient condition reports. Here they are:
· Good—Vital signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.
· Fair—Vital signs are stable and within normal limits. Patient is conscious but may be uncomfortable. Indicators are favorable.
· Serious—Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable.
· Critical—Vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.
Notice that “guarded” is not an option, but the guidelines lack specifics. Block pointed out that the indicators are not defined and the various descriptions such as excellent, favorable, questionable, and unfavorable are not explained. Serious and critical seem about the same to me, and a patient could be both critically ill and stable.
I am calling for the establishment of a task force made up of representatives from various medical disciplines, journalism, law, and public relations* to create new guidelines with better definitions. Let’s leave the term "guarded" to those in custody.
*and hospital administrators
Thanks to the 281 people who took the time to vote.