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The association between physician risk tolerance and imaging use in abdominal pain.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Pines, Jesse M. Hollander, Judd E. Isserman, Joshua A. Chen, Esther H. Dean, Anthony J. Shofer, Frances S. Mills, Angela M.
Description	Country affiliation: United States Author Affiliation: Pines JM ( Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. pinesjes@uphs.upenn.edu)
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.
File Format	HTM / HTML
ISSN	07356757
Issue Number	5
Volume Number	27
e-ISSN	15328171
Journal	The American Journal of Emergency Medicine
Language	English
Publisher	Elsevier
Publisher Date	2009-06-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Emergency Discipline Medicine Abdominal Pain Diagnosis Decision Making Diagnostic Imaging Utilization Physicians Psychology Physician's Practice Patterns Statistics & Numerical Data Adult Aged Emergency Service, Hospital Female Humans Male Middle Aged Outcome Assessment (health Care) Prospective Studies Journal Article
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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