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Parents' utilities for outcomes of occult bacteremia
J E Bennett1, W Sumner, S M Downs
1Department of Pediatrics, Washington University School of Medicine, St Louis, Mo, USA.
Insights
Parents prioritize their children
Area of Science:
- Pediatric Medicine
- Decision Analysis
- Health Economics
Background:
- Occult bacteremia is a serious concern in young children.
- Understanding parental values is crucial for treatment decisions.
- Utility assessment quantifies risk preferences for health outcomes.
Purpose of the Study:
- To determine parents' values for various outcomes of occult bacteremia.
- To utilize utility assessment to quantify risk preferences.
- To inform clinical decision-making regarding pediatric infections.
Main Methods:
- A computer-based utility assessment interview was conducted.
- Ninety-four parents of children aged 3-36 months participated.
- Parents valued outcomes including blood drawing, infection, hospitalization, and severe sequelae like meningitis or brain damage.
Main Results:
- Parents assigned high utility values to outcomes without permanent sequelae (e.g., blood drawing, local infection).
- Significantly lower values were assigned to severe outcomes like deafness, minor brain damage, severe brain damage, and death.
- No significant differences in values were observed based on child's fever or prior parental experience with outcomes.
Conclusions:
- Parents demonstrate a rational preference for transient, painful experiences over the risk of severe, permanent harm.
- Utility assessment reveals that parents highly value avoiding severe outcomes of occult bacteremia.
- Findings support the rationale for aggressive management to prevent rare but devastating complications.
Objective:
To describe parents' values for outcomes of occult bacteremia using utility assessment, a quantitative method that incorporates risk preference.
Design:
Computer-based utility assessment interview.
Setting:
Urban children's hospital pediatric emergency department with 50 000 visits annually.
Participants:
Convenience sample of parents presenting with a child between 3 and 36 months.
Main Outcome Measure:
Parents' utility values for 8 outcomes from treatment of occult bacteremia: blood drawing, localized infection, hospitalization for antibiotics, meningitis with recovery, meningitis resulting in deafness, minor brain damage, severe brain damage, and death.
Results:
Ninety-four subjects successfully completed the interview. Mean utilities were 0.9974 for blood drawing, 0.9941 for local infection, 0.9921 for hospitalization, 0.9768 for meningitis with recovery, 0.8611 for deafness, 0.7393 for minor brain damage, 0.3903 for severe brain damage, and 0.0177 for death. All values were significantly different from those that immediately preceded and succeeded (P<.0001), except for local infection vs hospitalization (P = .14). Median utilities for blood drawn, local infection, and hospitalization were 1. There were no significant differences among utilities of parents who presented with a febrile child (temperature > or =39 degrees C), or an afebrile child (temperature <39 degrees C). There were also no significant differences among utilities regardless of whether parents had children with prior experience with the outcomes.
Conclusions:
Assessment of utilities for outcomes of occult bacteremia yielded extremely high mean and median values for outcomes without permanent sequelae. This suggests that parents presenting to an emergency department may rationally prefer painful transient experiences, including venipuncture, for their children rather than risk even rare chances of severe outcomes.