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Validating a vignette-based instrument to study physician decision making in trauma triage
Deepika Mohan1,2, Baruch Fischhoff3, Coreen Farris4
1The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (DM, MRR, DCA).
Summary
Vignette-based instruments reliably assessed trauma triage decisions and identified differences between physician groups. However, these tools did not predict individual physician performance in real-world scenarios.
Area of Science:
- Medical Decision Making
- Trauma Surgery
- Emergency Medicine
Background:
- Vignettes are used to study physician decision-making, primarily for low-risk choices, with good group-level agreement with practice.
- The validity of vignettes for predicting high-risk decisions and individual physician behavior remains uncertain.
Purpose of the Study:
- To evaluate a previously developed vignette-based instrument for assessing physician decision-making in trauma triage.
- To measure the retest reliability, internal consistency, known-groups performance, and criterion validity of the trauma triage instrument.
Main Methods:
- Developed a vignette-based instrument for trauma triage decision-making.
- Assessed reliability and validity with emergency physicians and trauma surgeons.
- Compared vignette-based triage decisions (undertriage and overtriage) with actual practice through chart review.
Main Results:
- The instrument demonstrated good retest reliability (κ = 0.42) and internal consistency (Kuder-Richardson, 0.71-0.91).
- Trauma surgeons showed significantly lower undertriage rates (13%) compared to emergency physicians (70%).
- No significant correlation was found between individual vignette-based triage decisions and actual practice outcomes.
Conclusions:
- The trauma triage decision-making instrument is reliable and can differentiate between physician groups.
- The instrument's ability to predict individual physician performance in real-world trauma triage is limited.
