Barnett and Graves , in their commentary on our report recently published in Critical Care , suggested that timediscrete methods should be used to address time-dependent risk factors and competing risks. In this letter we comment on two statements by those authors. First, Barnett and Graves claim that, ‘An alternative method to the competing risks model is a multistate model. ’ In fact, a multistate model is not an alternative to modelling competing risks, but a competing risks model is an example of a multistate model. This is explained in the tutorial by Putter and coworkers . However, competing risks only model the time to first event and the event type (for example, time to nosocomial infection [NI]) or discharge/death, whatever comes first. To model subsequent events also, more complex multistate models are needed. Barnett and Graves give a
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