A Flowchart to Guide Emergency Physicians to Order Radiological Imaging in Pregnant Patients: Findings from an...

Area of Science:

• Emergency Medicine
• Radiology
• Obstetrics

Background:

• Physicians in emergency departments (EDs) may hesitate to order medically indicated imaging (MI) for pregnant patients.
• This hesitation can lead to delayed or omitted diagnostic procedures, impacting patient care.

Purpose of the Study:

• To assess the attitudes and practices of ED physicians concerning MI procedures in pregnant patients.
• To evaluate how physician training level influences these attitudes and practices.

Main Methods:

• A survey was conducted with 300 ED physicians: general practitioners, EM residents, and EM specialists.
• A questionnaire assessed demographics, experience, training, and attitudes/behaviors using a modified ACR Appropriateness Criteria framework.

Main Results:

• 88.7% of participants found managing pregnant trauma patients challenging and preferred to avoid these cases.
• EM specialists and residents were more likely to disregard gestational age for imaging decisions in unstable patients (p < 0.001).
• Physicians with relevant training were more likely to advocate immediate imaging regardless of gestational age (p = 0.001).

Conclusions:

• Significant heterogeneity exists in ED physicians' attitudes and practices regarding MI in pregnant patients.
• Decision-making is influenced by training, experience, and guideline accessibility.
• Improved education and standardized guidance are crucial for better decision-making and reduced maternal/fetal morbidity.