Computed Tomography Risk Disclosure in the Emergency Department: A Survey of Pediatric Emergency Medicine Fellowship Program Leaders

• Published in: The western journal of emergency medicine Vol. 19; no. 4; pp. 715 - 721
• Main Authors: Marin, Jennifer R, Thomas, Karen E, Mills, Angela M, Boutis, Kathy
• Format: Journal Article
• Language: English
• Published: United States Department of Emergency Medicine, University of California, Irvine School of Medicine 01.07.2018; eScholarship Publishing, University of California
• Subjects: Adolescent; Canada; Child; Child, Preschool; Cross-Sectional Studies; Disclosure; Emergency Service, Hospital; Fellowships and Scholarships; Female; Humans; Infant; Male; Neoplasms; Pediatric Emergency Medicine - organization & administration; Pediatrics; Physicians - statistics & numerical data; Risk Assessment; Surveys and Questionnaires; Tomography, X-Ray Computed - adverse effects; United States
• ISSN: 1936-9018; 1936-900X; 1936-9018
• DOI: 10.5811/westjem.2018.4.36895

Given the potential malignancy risks associated with computed tomography (CT), some physicians are increasingly advocating for risk disclosure to patients/families. Our goal was to evaluate the practices and attitudes of pediatric emergency medicine (PEM) fellowship program leaders' regarding CT radiation-risk disclosure. We conducted a cross-sectional survey study of the United States and Canadian PEM fellowship directors and associate/assistant directors. We developed a web-based survey using a modified Dillman technique. Primary outcome was the proportion who "almost always" or "most of the time" discussed potential malignancy risks from CT prior to ordering this test. Of 128 physicians who received the survey, 108 (86%) responded. Of those respondents, 73%, 95% confidence interval (CI) [64-81] reported "almost always" or "most of the time" discussing potential malignancy risks when ordering a CT for infants; proportions for toddlers, school-age children, and teenagers were 72% (95% CI [63-80]), 66% (95% CI [56-75]), and 58% (95% CI [48-67]), respectively (test for trend, p=0.008). Eighty percent reported being "extremely" or "very" comfortable discussing radiation risks. Factors of "high" or "very high" importance in disclosing risks included parent request for a CT not deemed clinically indicated for 94% of respondents, and parent-initiated queries about radiation risks for 79%. If risk disclosure became mandatory, 82% favored verbal discussion over written informed consent. PEM fellowship program leaders report frequently disclosing potential malignancy risks from CT, with the frequency varying inversely with patient age. Motivating factors for discussions included parental request for a CT deemed clinically unnecessary and parental inquiry about risks.