Authorities say Maj. Nidal Malik Hasan, a U.S. Army psychiatrist, killed 13 people and injured 30 yesterdayat Fort Hood before a civilian police officer shot him four times. An Army spokesperson has announced that Hasan is in “stable” condition while of some of the victims are listed as “critical.” But what does that mean? In July 2001, the Explainer probed vague medical conditions after an 8-year-old boy was listed as “critical but stable” following a shark attack.
The press has described the medical condition of Jessie Arbogast, the 8-year-old mauled by a shark in Florida, as “critical but stable.” What do patient descriptions such as “critical” and “stable” mean?
Most hospitals adhere to American Hospital Association guidelines when describing a patient’s condition to the media. Those guidelines instruct hospital spokespersons to give out only a one-word description of a patient’s condition. The recommended conditions, which are excerpted from the AHA’s “General Guide for the Release of Information on the Condition of Patients,” are:
Undetermined: Patient awaiting physician and assessment.
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.
The term “vital signs” means indicators such as blood pressure, pulse, temperature, and respiration. The one-word descriptions are not medical terms, and they are more art than science. They’re based on a doctor’s best judgment of a patient’s condition, as relayed to hospital spokespersons.
The AHA’s “General Guide” adds: “‘Stable’ should not be used as a condition. Furthermore, this term should not be used in combination with other conditions, which by definition often indicate a patient is unstable.” (As one hospital spokesman put it, “You can be dead and be stable.”)
So how can Jessie Arbogast’s condition be “critical but stable”?
Not all hospitals follow the AHA guidelines strictly. They’re advisory guidelines, after all, not regulations. George Washington University Hospital in Washington, D.C., for example, uses its own definitions. GW Hospital defines critical condition as “uncertain prognosis, vital signs are unstable or abnormal, there are major complications, and death may be imminent.” Many hospitals use the term “treated and released” to describe patients who received treatment but were not admitted. And the phrase “critical but stable” is in widespread use, though it’s not recommended by the AHA. The phrase is an attempt to communicate that some patients’ conditions are more “critical” than others.
Sacred Heart Children’s Hospital in Pensacola, Fla., where Jessie Arbogast is being treated, doesn’t follow AHA terminology strictly. “I try to stick to those four, but sometimes when I call to check, the doctor will say ‘stable’ or ‘guarded,’ and so that’s what you have relay,” hospital spokesman Mike Burke says. “Someone’s medical condition is a complex matter. It’s really unrealistic to give a one-word description of how they’re doing, but because of restrictions we’re under, that’s what we do.”
Explainer thanks Marti Harris ofGeorgeWashingtonUniversityHospital, LeRoy Tillman of theWashingtonHospitalCenter, and Mike Burke of the Sacred Heart Health System.