How much risk are emergency department patients willing to accept to avoid diagnostic testing

Jeremy Padalecki; K. Tom Xu; Cynthia Smith; Lynn Carrasco; Justin Hensley; Peter B. Richman

doi:10.1016/j.tjem.2016.09.009

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

Abstract

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.