The association between physician risk tolerance and imaging use in abdominal pain

Pines, Jesse M.; Hollander, Judd E.; Isserman, Joshua A.; Chen, Esther H.; Dean, Anthony J.; Shofer, Frances S.; Mills, Angela M.

doi:10.1016/j.ajem.2008.04.031

« Previous Next »American Journal of Emergency Medicine
Volume 27, Issue 5 , Pages 552-557, June 2009

The association between physician risk tolerance and imaging use in abdominal pain

Jesse M. Pines, MD, MBA, MSCE
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
- The Leonard Davis Institute Of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Corresponding author. Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Tel.: +1 215 662 4050.
Judd E. Hollander, MD
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
Joshua A. Isserman, MS
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA 19104, USA
Esther H. Chen, MD
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
Anthony J. Dean, MD
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
Frances S. Shofer, PhD
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
Angela M. Mills, MD
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA

Received 27 March 2008; accepted 28 April 2008.

Abstract

Objective

We sought to determine the impact of 3 validated scales of physician risk behavior on imaging use in emergency department (ED) patients with abdominal pain.

Methods

We performed a prospective cohort study of nonpregnant ED patients with acute, nontraumatic abdominal pain and then administered 3 instruments (a risk-taking subscale of the Jackson Personality Index, the stress from uncertainty scale, and a malpractice fear scale) to attending physicians who had evaluated these patients and made decisions regarding abdominal imaging. Outcomes were the use of abdominal pelvic computed tomography (CT) and any imaging use (CT, ultrasound, or abdominal plain film). Hierarchical logistic regression was used to determine the effect of risk scales on abdominal imaging use.

Results

Of 838 patients with acute abdominal pain, 487 (58%) received imaging studies; 395 (47%) received an CT, 111 (13%) ultrasound, and 122 (15%) an abdominal plain film. Both CT and any imaging use were lower among the physicians who were least risk-averse as measured by the risk-taking subscale (highest quartiles vs 3 lower quartiles). In adjusted analysis, probability of CT in the least risk-averse group was 35% (95% confidence interval [CI], 28%-44%) compared to 50% (95% CI, 45%-54%) among more risk-averse physicians, and the probability of any imaging was 53% (95% CI, 44%-61%) compared to 64% (95% CI, 61%-68%). Malpractice fear and stress due to uncertainty were not predictive of imaging use.

Conclusion

Self-reported physician risk-taking behavior predicts the use of imaging in ED patients with abdominal pain, whereas malpractice fear and stress due to uncertainty do not.