Related Experiment Videos
Physicians' Risk Tolerance and Head Computed Tomography Use for Pediatric Patients With Minor Head Injury
Chi-Yung Cheng1, Hsiu-Yung Pan1, Chao-Jui Li1
1From the Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung.
Insights
Physician risk tolerance influences head CT scans in pediatric minor head injuries. More risk-averse doctors ordered more scans, impacting head injury diagnosis and treatment.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Making
- Medical Imaging
Background:
- Traumatic brain injury (TBI) is a major cause of childhood death and disability globally.
- Head computed tomography (CT) is a key diagnostic tool for evaluating minor head injuries (MHI) in children.
- Understanding factors influencing CT utilization is crucial for optimizing care.
Purpose of the Study:
- To investigate the association between emergency physician (EP) risk tolerance and head CT use in pediatric patients with MHI.
- To explore the relationship between physician risk-taking behavior and diagnostic imaging decisions in the emergency department (ED).
Main Methods:
- Retrospective analysis of pediatric patients (<17 years) with MHI in the ED.
- Administration of risk-taking subscale (RTS) and malpractice fear scale (MFS) questionnaires to attending EPs.
- Primary outcome: head CT use; Secondary outcomes: ED length of stay and intracranial injury (ICI) diagnosis.
Main Results:
- Of 523 MHI patients, 44.6% received a head CT; 3.1% had an ICI diagnosis.
- Risk-averse EPs ordered head CTs more frequently (56.96%) than risk-tolerant EPs (37.37%).
- Physician risk tolerance (RTS) was significantly associated with head CT use (OR, 8.463; CI, 2.783-25.736).
Conclusions:
- Individual EP risk tolerance, assessed by RTS, predicts head CT utilization in pediatric MHI cases.
- Physician's inherent risk tolerance, not fear of malpractice, appears to be a key driver of CT ordering behavior.
- Further research may explore strategies to standardize CT use based on objective clinical criteria.
Objectives:
Traumatic brain injury is the leading cause of death and disability in children worldwide. The objective of this study was to determine the association between physician risk tolerance and head computed tomography (CT) use in patients with minor head injury (MHI) in the emergency department (ED).
Methods:
We retrospectively analyzed pediatric patients (<17 years old) with MHI in the ED and then administered 2 questionnaires (a risk-taking subscale [RTS] of the Jackson Personality Inventory and a malpractice fear scale [MFS]) to attending physicians who had evaluated these patients and made decisions regarding head CT use. The primary outcome was head CT use during ED evaluation; the secondary outcome was ED length of stay and final diagnosis of intracranial injury (ICI).
Results:
Of 523 patients with MHI, 233 (44.6%) underwent brain CT, and 16 (3.1%) received a final diagnosis of ICI. Among the 16 emergency physicians (EPs), the median scores of the MFS and RTS were 22 (interquartile range, 17-26) and 23 (interquartile range, 19-25), respectively. Emergency physicians who were most risk averse tended to order more head CT scans compared with the more risk-tolerant EPs (56.96% vs 37.37%; odds ratio, 8.463; confidence interval, 2.783-25.736). The ED length of stay (P = 0.442 and P = 0.889) and final diagnosis (P = 0.155 and P = 0.835) of ICI were not significantly associated with the RTS and MFS scores.
Conclusions:
Individual EP risk tolerance, as measured by RTS, was predictive of CT use in pediatric patients with MHI.