The association between physician risk tolerance and imaging use in abdominal pain
The association between physician risk tolerance and imaging use in abdominal pain
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DOI：
10.1016/j.ajem.2008.04.031
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发表时间：
2009-06-01
影响因子：
3.6
通讯作者：
Mills, Angela M.
中科院分区：
文献类型：
--
作者：
Pines, Jesse M.;Hollander, Judd E.;Mills, Angela M.
目的：我们试图确定3个经验证的医生风险行为量表对急诊科（艾德）腹痛患者使用成像的影响。我们对患有急性非创伤性腹痛的非妊娠艾德患者进行了一项前瞻性队列研究，（杰克逊人格指数中的一个冒险子量表，来自不确定性的压力量表，和医疗事故恐惧量表）给主治医师，这些主治医师已经评估了这些患者并做出了关于腹部成像的决定。结果是腹部盆腔计算机断层扫描（CT）和任何影像学检查（CT、超声或腹部平片）的使用。分层Logistic回归分析用于确定风险量表对腹部成像use.Results的影响：838例急性腹痛患者中，487例（58%）接受了影像学检查; 395例（47%）接受了CT检查，111例（13%）超声检查，122例（15%）腹部平片检查。在风险承担子量表（最高四分位数vs 3个较低四分位数）测量的风险厌恶程度最低的医生中，CT和任何成像的使用都较低。在校正分析中，风险厌恶程度最低组的CT概率为35%（95%置信区间[CI]，28%-44%），而风险厌恶程度较高的医生组为50%（95% CI，45%-54%），任何成像的概率为53%（95% CI，44%-61%），而风险厌恶程度较高的医生组为64%（95% CI，61%-68%）。医疗事故的恐惧和压力，由于不确定性没有预测的成像use.Conclusion：自我报告的医生冒险行为预测使用成像在艾德患者腹痛，而医疗事故的恐惧和压力，由于不确定性不。(C)2009 Elsevier Inc. All rights reserved.
Objective: We sought to determine the impact of 3 validated scales of physician risk behavior on imaging use in emergency department (ED) patients with abdominal pain.Methods: We performed a prospective cohort study of nonpregnant ED patients with acute, nontraumatic abdominal pain and then administered 3 instruments (a risk-taking subscale of the Jackson Personality Index, the stress from uncertainty scale, and a malpractice fear scale) to attending physicians who had evaluated these patients and made decisions regarding abdominal imaging. Outcomes were the use of abdominal pelvic computed tomography (CT) and any imaging use (CT, ultrasound, or abdominal plain film). Hierarchical logistic regression was used to determine the effect of risk scales on abdominal imaging use.Results: Of 838 patients with acute abdominal pain, 487 (58%) received imaging studies; 395 (47%) received an CT, 111 (13%) ultrasound, and 122 (15%) an abdominal plain film. Both CT and any imaging use were lower among the physicians who were least risk-averse as measured by the risk-taking subscale (highest quartiles vs 3 lower quartiles). In adjusted analysis, probability of CT in the least risk-averse group was 35% (95% confidence interval [CI], 28%-44%) compared to 50% (95% CI, 45%-54%) among more risk-averse physicians, and the probability of any imaging was 53% (95% CI, 44%-61%) compared to 64% (95% CI, 61%-68%). Malpractice fear and stress due to uncertainty were not predictive of imaging use.Conclusion: Self-reported physician risk-taking behavior predicts the use of imaging in ED patients with abdominal pain, whereas malpractice fear and stress due to uncertainty do not. (C) 2009 Elsevier Inc. All rights reserved.