On Wednesday afternoon, MedStar Washington Hospital Center released an update on two patients who had been transported to the facility that morning. One of them was House Majority Whip Steve Scalise (R-La.), whose office released a statement earlier in the day stating that he was “in stable condition.”
MedStar Washington’s update used less reassuring language.
Rep. Scalise was critically injured and remains in critical condition. The other patient is in good condition.
— MedStar Washington (@MedStarWHC) June 14, 2017
Curious about the distinction of the terminology used, I called Joseph Clinton, former head of the department of emergency medicine at the University of Minnesota.
Clinton noted that there were various definitions for “critical condition,” but that it generally meant that there was “a critical life or limb threat that needs close to immediate treatment to prevent death or disability.” A patient in critical condition would be in an intensive care unit, having their vital signs monitored, perhaps with devices to assist with breathing. This, he said, was the most serious condition for a living patient.
He contrasted it with a patient who was in good condition.
“You and I are probably in good condition right now,” he said, by way of defining that term in an emergency context. “We’re not worried about rapid deterioration of blood pressure or breathing.” Such a patient, he said, would be stable.
Clinton noted, though, that he was speaking from the context of an emergency room physician, in which a patient’s condition is more binary. “For me,” he said, “it’s critically ill or stable.”
The American Hospital Association publishes a manual titled, “Guidelines for Releasing Information on the Condition of Patients,” which articulate more gradations of conditions. Excluding “undetermined,” used for those who’ve not yet been examined, the AHA categories are as follows.
- 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.”
MedStar Washington adds a subcategory to the list above: “Critical but stable.” The AHA notes that doctors will often use this term to indicate “patients who are expected to recover,” but it recommends that the term not be used when speaking publicly about a patient’s condition specifically because it can lead to confusion. After all, part of the definitions of “serious” and “critical” are that vital signs aren’t stable.
In this case, MedStar Washington chose not to use the “critical but stable” descriptor for Scalise.