Physicians' attitudes toward misdiagnosis of pulmonary embolism: A utility analysis

Abstract

The purpose of this study was to measure physicians' utilities for outcomes after ventilation-perfusion lung scanning and to explore physicians' attitudes toward misdiagnosis and the treatment of patients suspected of having pulmonary embolism (PE) in a quantitative manner by using a utility analysis. Before ordering lung scanning for suspected PE, physicians rated five possible outcomes on a scale of 0-100 by using a computer order-entry system. These responses were rescaled and transformed to a utility measure by using the Torrance transformation. The mean utility for the potential outcomes after 341 lung scans were (a) no PE and no treatment (true-negative, 93 +/- 22 [mean +/- standard deviation]), (b) PE with appropriate treatment (true-positive, 84 +/- 24), (c) no PE but patient received treatment (false-positive, 54 +/- 32), (d) PE but patient did not receive treatment (false-negative, 14 +/- 23), and (e) death during pulmonary angiography (2 +/- 11). After lung scanning for acute PE, physicians placed greatest value on excluding the diagnosis (true-negative). Providing unnecessary treatment (false-positive) was valued in the midrange of utilities. The value of missing PE (false-negative) was rated almost equal to that of dying during pulmonary angiography. Physicians consider providing treatment for PE without objective confirmation of an embolus to be preferable to missing a case of PE.