Patient Attitudes Regarding Consent for Emergency Department Computed Tomography Scans

Study Objectives: With increasing awareness of physicians and layperson inregards to the radiation exposure associated with computed tomography (CT) scans, it is unclear whether a formal patient consent process for CT’s should exist. The existing literature does not reflect the current attitudes of patients regarding this important issue. We set out to assess patient attitudes about obtaining informed consent regarding emergency department (ED) CT scans. Methods: In this pilot study, surveys were distributed over a two-month period in fiscal year 2010 by utilizing a convenience sample of patients during weekday hours in a tertiary, suburban level-one trauma center with a yearly census of 74,000 patients. Historically, in this same fiscal year at this site, patients received a CT scan on 25% of their ED visits. Using simple frequency and proportions, we evaluated patients’ attitudes regarding obtaining informed consent prior to performing CT scans in the ED. After obtaining IRB approval, a convenience sample of approximately fifty surveys was obtained which represented a 90% return rate of surveys distributed. Either an ED registrar or a research assistant filled in the triage level on the survey and then gave the survey to the patient or patient’s surrogate to complete. A brief explanation of the study was provided to ensure that participation was voluntary and that subjects were reassured as to the anonymity of their response.The survey consisted of seventeen yes/no or multiple-choice questions, five of which were demographic questions. When completed, the surveys were placed in a sealed envelope and returned to research staff or by mail to the research department. Results: The median respondent age was 60 years or older, with a nearly even proportion of men to women (51%:49%). Ninety percent identified themselves as white or non-Hispanic or non-Latino. Ten percent identified themselves as black, Black or other. Ninety-eight percent identified english as his or her primary language. The majority (71%, 36/51) of survey respondents were high school graduates or had some college. Seventy-three percent (35/48) of the subjects did not expect to get a CT and 27% (13/48) did expect to receive a CT during their ED visit on the day they were surveyed. Seventy-three percent (36/49) of respondents felt that patients in the ED should give informed consent before they get a CT scan in the ED and eighty-six percent (42/49) felt either comfortable or very comfortable letting the ED physician decide if a patient needs a CT scan. Only six percent (3/49) either had themselves or had known of anyone having a problem that was caused by a CT scan. Conclusion: Based on this pilot study, the majority or emergency department patients feel informed consent should occur before receiving a CT scan and most patients feel comfortable letting the physician make the decision regarding the need for a CT scan

Research Priorities for the Influence of Gender on Diagnostic Imaging Choices in the Emergency Department Setting.

Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes. Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised