Abstract
IntroductionGiven 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.MethodsWe 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.ResultsOf 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.ConclusionPEM 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.
Highlights
Given the potential malignancy risks associated with computed tomography (CT), some physicians are increasingly advocating for risk disclosure to patients/families
Previous studies of physician disclosure of CT malignancy risks have focused on general emergency physicians[12,13,23] who primarily care for adult patients,[24] radiologists,[25] and pediatric surgeons.[26]
Our study indicates that pediatric emergency medicine (PEM) fellowship program leaders report commonly discussing potential malignancy risks with patients’ parents/guardians, with the frequency increasing with younger patient age
Summary
Given the potential malignancy risks associated with computed tomography (CT), some physicians are increasingly advocating for risk disclosure to patients/families. Computed Tomography Risk Disclosure in the Energency Department childhood.[3] As a result, some physicians advocate for disclosure of possible malignancy risks prior to ordering CT imaging in children. CT is a commonly ordered test by pediatric emergency medicine (PEM) physicians,[4] and children are among the most sensitive to the potential long-term effects of radiation.[5] Despite this, there has been limited investigation and no firm recommendations for implementing risk disclosure practices for CT imaging of pediatric patients in the emergency department (ED). There are differences in imaging practices between the United States and Canada,[8] which may translate into differences in risk-disclosure practice
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