Physician Risk Tolerance and Head Computed Tomography Use for Patients with Isolated Headaches

Huang, Yufei; Syue, Yuan-Jhen; Yen, Yung-Lin; Wu, Chien-Hung; Ho, Yu-Ni; Cheng, Fu-Jen

doi:10.1016/j.jemermed.2016.06.012

Cited by 12 publications

(19 citation statements)

References 31 publications

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“…In addition, variations in personal risk-taking behavior also influence imaging use in patients who present with abdominal pain [12]. Another study [3] found that individual EP risk tolerance measured by the RTS, was not predictive of CT use in patients with isolated headaches. In the present study, the most risk-tolerant EPs tend to order less CT and the decline of CT use, after intervention, was more significant (OR = 0.530, CI = 0.311-0.889).…”

Section: Discussionmentioning

confidence: 99%

“…Headaches, one of the most common reasons adults seek medical advice, account for about 1.84-4.5% of emergency department (ED) visits [1][2][3]. There are many causes of headaches, from benign and self-limiting, to serious and life-threatening causes.…”

Section: Introductionmentioning

confidence: 99%

“…There are many causes of headaches, from benign and self-limiting, to serious and life-threatening causes. Intracranial pathology (ICP) accounts for about 2.5-3.8% of patients reporting to the ED for headaches [1,3]. It is challenging for emergency physicians (EPs) to distinguish between the few patients with life-threatening headaches and the overwhelming majority with benign headaches.…”

Section: Introductionmentioning

confidence: 99%

“…A missed or delayed diagnosis of headache with ICP, especially subarachnoid hemorrhage, might also lead to treatment delays or medical disputes. A previous study focused on EPs' risk tolerance and the association with ED CT use for isolated headache [3]. Another study evaluated the effect of peer influence on changing disposition decisions by EPs [11].…”

Section: Introductionmentioning

confidence: 99%

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The effect of peer influence on the use of CT by emergency physicians for patients with headaches

Huang

Tseng

Chiang

et al. 2019

The American Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of peer influence on the use of CT by emergency physicians for patients with headaches

Huang

Tseng

Chiang

et al. 2019

The American Journal of Emergency Medicine

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“…Accordingly, as proof of concept we hypothesized that among physicians responding to a sepsis clinical vignette, risk of guideline discordance would increase by compelling faster decisions with a mandatory time constraint and decrease by slowing decisions through choice overload. 14,15 Furthermore, because individual predisposition towards intuitive or analytical thinking varies 16,17 and risk tolerance has a potentially substantial impact on clinical decisionmaking, [18][19][20][21] we hypothesized that the effects of each choice architecture intervention are modi ed by individual physician characteristics.…”

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confidence: 99%

The Impact of Choice Architecture on Clinical Decision-Making in Sepsis: A Proof of Concept Study

Mansoori¹,

Clark²,

Havranek³

et al. 2020

Preprint

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Background: Despite improved survival and increasing hospital mandates, discordance with sepsis resuscitation guidelines is common. We sought to determine whether choice architecture can promote faster or slower decision-making among physicians and the associated risk of guideline-discordance in sepsis.Methods: We conducted an electronic, survey-based time-to-event analysis using a sepsis clinical vignette and multivariable Cox proportional hazards regression. Respondents included physicians from multiple specialties and levels of training at an academic tertiary-care hospital and academic safety-net hospital. Respondents were randomized to one of three distinct answer sets: control (6 options with no time limit), time constraint (10 seconds, intended to promote faster thinking) or choice overload (24 options, intended to promote slower thinking). The primary outcomes were response time and discordance with Surviving Sepsis Campaign 2016 fluid resuscitation guidelines, adjusting for physician characteristics. Physician risk tolerance and predisposition towards intuitive or analytical thinking were assessed for effect modification.Results: 189 of 624 (30.3%) physicians completed the survey. Total response time was lower in time constraint (45.8s, IQR 38.3s-56.6s, P<0.001) and higher in choice overload (94.2s, IQR 73.0s-142.6s, P=0.005) groups compared to control (71.5s, IQR 52.6s-100.6s). In contrast, relative hazard for guideline discordance was increased in time constraint (3.38, 1.97-5.79, P<0.001) and decreased in choice overload (0.52, 0.30-0.93, P=0.03) groups dependent on Cognitive Reflection Test (7.87, 1.80-34.44, P=0.006) and risk tolerance scores (JPI-RTS 2.00, 1.05-3.84, P=0.04 and MFS 0.42, 0.20-0.88, P=0.02), respectively.Conclusions: Choice architecture may impact clinical decisions and guideline discordance in sepsis, warranting further investigation in real-world contexts.

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Attitudes toward risk among emergency physicians and advanced practice clinicians in Massachusetts

et al. 2021

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Objective Risk aversion is a personality trait influential to decision making in medicine. Little is known about how emergency department (ED) clinicians differ in their attitudes toward risk taking. Methods We conducted a cross‐sectional survey of practicing ED clinicians (physicians and advanced practice clinicians [APCs]) in Massachusetts using the following 4 existing validated scales: the Risk‐Taking Scale (RTS), Stress from Uncertainty Scale (SUS), the Fear of Malpractice Scale (FMS), and the Need for (Cognitive) Closure Scale (NCC). We used Cronbach's α to assess the reliability of each scale and performed multivariable linear regressions to analyze the association between the score for each scale and clinician characteristics. Results Of 1458 ED clinicians recruited for participation, 1116 (76.5%) responded from 93% of acute care hospitals in Massachusetts. Each of the 4 scales demonstrated high internal consistency reliability with Cronbach's αs ranging from 0.76 to 0.92. The 4 scales also were moderately correlated with one another (0.08 to 0.54; all P < 0.05). The multivariable results demonstrated differences between physicians and APCs, with physicians showing a greater tolerance for risk or uncertainty (NCC difference, −3.58 [95% confidence interval, CI, −5.26 to −1.90]; SUS difference, −3.14 [95% CI: −4.99 to −1.29]) and a higher concern about malpractice (FMS difference, 1.14 [95% CI, 0.11–2.17]). Differences were also observed based on clinician age (a proxy for years of experience), with greater age associated with greater tolerance of risk or uncertainty (age older than 50 years compared with age 35 years and younger; NCC difference, −2.84 [95% CI, −4.69 to −1.00]; SUS difference, −4.71 [95% CI, −6,74 to −2.68]) and less concern about malpractice (FMS difference, −3.19 [95% CI, −4.31 to −2.06]). There were no appreciable differences based on sex, and there were no consistent associations between scale scores and the practice and payment characteristics assessed. Conclusion We found that risk attitudes of ED clinicians were associated with type of training (physician vs APC) and age (experience). These differences suggest one possible explanation for the observed differences in decision making.

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Physician Risk Tolerance and Head Computed Tomography Use for Patients with Isolated Headaches

Cited by 12 publications

References 31 publications

The effect of peer influence on the use of CT by emergency physicians for patients with headaches

The effect of peer influence on the use of CT by emergency physicians for patients with headaches

The Impact of Choice Architecture on Clinical Decision-Making in Sepsis: A Proof of Concept Study

Attitudes toward risk among emergency physicians and advanced practice clinicians in Massachusetts

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