The association between physician risk tolerance and imaging use in abdominal pain.
Publication/Presentation Date
6-1-2009
Abstract
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.
Volume
27
Issue
5
First Page
552
Last Page
557
ISSN
1532-8171
Published In/Presented At
Pines, J. M., Hollander, J. E., Isserman, J. A., Chen, E. H., Dean, A. J., Shofer, F. S., & Mills, A. M. (2009). The association between physician risk tolerance and imaging use in abdominal pain. The American journal of emergency medicine, 27(5), 552–557. https://doi.org/10.1016/j.ajem.2008.04.031
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
19497460
Department(s)
Administration and Leadership
Document Type
Article