Purpose or Case Report: Awareness of the need for benefit:risk assessment prior to imaging studies has increased dramatically over the past decade, but the impact of this on the disclosure practice of Emergency Department (ED) Physicians is not known. Our aim was to assess ED physician practice and attitudes towards CT radiation risk disclosure for stable patients.
Methods & Materials: Electronic Survey of all USA and Canadian Emergency Medicine Residency Program Directors and Associate/Assistant Directors.
Results: Response rate was 51 % (276/545), with most (83%) respondents stating that their routine practice included at least some pediatric patients. Reported rates of discussion (almost always or most of the time) of potential radiation risks with stable patients and their families were inversely related to patient age (> 65 yrs 5%, 41-65 yrs 21%, 19-40 yrs 50%, 0-18 yrs 76%). Discussion was most likely if there was discordance in family vs physician perception of need for CT, or if the patient/family directly asked for information. Factors most relevant to the decision not to discuss risk were the lower risk in the elderly or patients with reduced life expectancy, time pressure and concern that refusal might compromise patient care. 43% of respondents correctly identified the future excess cancer mortality risk associated with Head CT, and 83% were aware that the risk is higher in children. Most respondents (84%) would favour verbal informed discussion over written informed consent if risk disclosure became standard of care. Familiarity with Image Gently and Image Wisely Campaigns was only moderate compared to clinical campaigns such as Choosing Wisely. Although 57% of respondents now feel comfortable (extremely or very) in discussing CT risks with patients and their families, most would appreciate further educational tools.
Conclusions: Our survey suggests that risk disclosure and discussion is becoming a more frequent part of routine ED care for patients undergoing CT. Most ED physicians are aware of the greater potential risk in younger patients, and this is reflected in a higher rate of discussion with pediatric and young adult patients/families. Opportunities to improve patient care through collaboration and dissemination of knowledge between Diagnostic Imaging and the Emergency Department exist.