A survey of emergency physicians' fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma

Andrew Wong, Terry Kowalenko, Stephanie Roahen-Harrison, Barbara Smith, Ronald F. Maio, Rachel M. Stanley

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Objective: The objective of the study was to determine whether fear of malpractice is associated with emergency physicians' decision to order head computed tomography (CT) in 3 age-specific scenarios of pediatric minor head trauma. We hypothesized that physicians with higher fear of malpractice scores will be more likely to order head CT scans. Methods: Board-eligible/board- certified members of the Michigan College of Emergency Physicians were sent a 2-part survey consisting of case scenarios and demographic questions. Effect of fear of malpractice on the decision to order a CT scan was evaluated using a cumulative logit model. Results: Two hundred forty-six members (36.5%) completed the surveys. In scenario 1 (infant), being a male and working in a university setting were associated with reduced odds of ordering a CT scan (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.18-0.88; and OR, 0.35; 95% CI, 0.13-0.96, respectively). In scenario 2 (toddler), working for 15 years or more, at multiple hospitals, and for a private group were associated with reduced odds of ordering a CT scan (OR, 0.46; 95% CI, 0.26-0.79; OR, 0.36; 95% CI, 0.16-0.80; and OR, 0.51; 95% CI, 0.27-0.94, respectively). No demographic variables were significantly associated with ordering a CT scan in scenario 3 (teen). Overall, the fear of malpractice was not significantly associated with ordering a CT scan (OR, 1.28; 95% CI, 0.73-2.26; and OR, 1.70; 95% CI, 0.97-3.0). Only in scenario 2 was high fear significantly associated with increased odds of ordering a CT scan (OR, 2.09; 95% CI, 1.08-4.05). Conclusions: Members of Michigan College of Emergency Physicians with a higher fear of malpractice score tended to order more head CT scans in pediatric minor head trauma. However, this trend was shown to be statistically significant only in 1 case and not overall.

Original languageEnglish (US)
Pages (from-to)182-185
Number of pages4
JournalPediatric Emergency Care
Volume27
Issue number3
DOIs
StatePublished - Mar 1 2011
Externally publishedYes

Keywords

  • computed tomography
  • Malpractice
  • mild traumatic brain injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

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