Written Informed Consent for Computed Tomography of the Abdomen/Pelvis is Associated with Decreased CT Utilization in Low-Risk Emergency Department Patients

Western Journal of Emergency Medicine

卷:16

Katherine L. Heilpern¹  Douglas W. Lowery-North¹  Kimberly E. Applegate²  Laura A. Ward³  Lisa H. Merck⁴  Esther Choo⁵ 

[1] Emory University School of Medicine and Grady Memorial Hospital, Department of Emergency Medicine, Atlanta, Georgia;

[2] Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia;

[3] Rollins School of Public Health, Department of Biostatistics, Emory University, Atlanta, Georgia;

[4] The Warren Alpert Medical School of Brown University, Department of Emergency Medicine and Diagnostic Imaging, Providence, Rhode Island;

[5] The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island;

关键词: Emergency Medicine;    Ethics;    CT Scan;    Computerized Tomography;   

DOI  :  10.5811/westjem.2015.9.27612

来源: DOAJ

【 摘 要 】

Introduction: The increasing rate of patient exposure to radiation from computerized tomography(CT) raises questions about appropriateness of utilization. There is no current standard to employinformed consent for CT (ICCT). Our study assessed the relationship between informed consent andCT utilization in emergency department (ED) patients.Methods: An observational multiphase before-after cohort study was completed from 4/2010-5/2011.We assessed CT utilization before and after (Time I/ Time II) the implementation of an informedconsent protocol. Adult patients were included if they presented with symptoms of abdominal/pelvicpathology or completed ED CT. We excluded patients with pregnancy, trauma, or altered mentalstatus. Data on history, exam, diagnostics, and disposition were collected via standard abstractiontool. We generated a multivariate logistic model via stepwise regression, to assess CT utilizationacross risk groups. Logistic models, stratified by risk, were generated to include study phase and apropensity score that controlled for potential confounders of CT utilization.Results: 7,684 patients met inclusion criteria. In PHASE 2, there was a 24% (95% CI [10-36%])reduction in CT utilization in the low-risk patient group (p<0.002). ICCT did not affect CT utilization in thehigh-risk group (p=0.16). In low-risk patients, the propensity score was significant (p<0.001). There wereno adverse events reported during the study period.Conclusion: The implementation of ICCT was associated with reduced CT utilization in low-risk EDpatients. ICCT has the potential to increase informed, shared decision making with patients, as wellas to reduce the risks and cost associated with CT.

【 授权许可】

Unknown