Decision making in emergency laparotomy: updated results of an international multi disciplinary judgement analysis study

Abstract

Abstract Aims The aim of our study is to assess how professionals take decisions when evaluating suitability of patients for emergency laparotomy or palliation. Methods We created and validated a dataset of 90 case vignettes based on real patients admitted with surgical pathology correctable only via an emergency laparotomy. We removed information concerning real life outcomes. We submitted the vignettes to consultants and trainees in surgery, anaesthesia and intensive care, asking them if they would offer an emergency laparotomy. Concordance between assessors and real life decisions, accuracy scores (the lower the value the higher the likelihood of operating on patients that survived) and inconsistency scores were calculated. Judgement Analysis methodology (binomial logistic regression) was used to identify variables relevant to the decision making process for each participant. Results This report includes results for the first 110 participants. Thirteen centres provided data (4 from Italy, 8 from the UK, 1 from Greece). 54 consultants, 39 registrars, 13 core trainees participated. 68 were surgeons, 26 anaesthetists and 9 intensivists. Median concordance between decision makers and real life was 78.9%. Median accuracy was 17 (IQR 11-34.3). Median inconsistency was 13% (IQR 7%-20%). Concordance, accuracy and consistency strongly correlated with each other and were better for consultants and worse for trainees. Judgment Analysis demonstrated differences between grades, specialities and institutions. Conclusions Different clinicians, when faced with the same information, make different decisions. Our updated data supports the adoption of multidisciplinary decision making protocols as well as senior involvement.