How much risk are emergency department patients willing to accept to avoid diagnostic testing
Jeremy Padalecki1, K. Tom Xu2, Cynthia Smith1, Lynn Carrasco1, Justin Hensley1, Peter B. Richman1
1Department of Emergency Medicine, Christus Spohn/Texas A&M Health Science Center, Corpus Christi, TX, United States
2Texas Tech University Health Sciences Center, Lubbock, TX, United States
Keywords: Risk tolerance; Emergency department; Shared decision making
Objectives: There is a paucity of research evaluating the risk tolerance of Emergency Department (ED) patients. We hypothesized that a significant percentage of ED patients surveyed would be comfortable with ≥5% risk of adverse outcome if they avoided testing in several hypothetical scenarios.
Materials and methods: This was a cross-sectional study of a convenience sample of stable inner-city ED patients. Patients completed a written survey and were asked four closed-answer questions regarding risk tolerance/willingness to refuse a test/procedure, including the following scenarios: #1: LP following CT head; #2 overnight serial troponins for rule out myocardial infarction; #3 CT for possible appendicitis, #4 parent deciding whether child should undergo head CT for low risk head injury. Risk preferences were stratified to ≥5% (high) and <5% (low). Multivariate logistic regressions performed for each scenario to control for confounding factors.
Results: There were 217 patients in the study group; mean age 42 ± 15 years, 48% female, 66% Hispanic, 87% income < $40,000 income group. A substantial percentage of patients rated high risk tolerance for each scenario, including 31% for #1 (avoid LP), 25% for #2 (avoid cardiac rule-out admission), 27% for #3 (avoid CT for appendicitis), and 19% for #4 (avoid head CT for child).
Discussion: For 3 of 4 scenarios, 25% or more of our patients would accept a high risk tolerance of adverse outcome to avoid further testing.
Conclusion: Our findings contribute further evidence to the growing body of literature supporting patient interest in shared decision making in the ED.