Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Am J Emerg Med. 2010 Sep;28(7):771-9. doi: 10.1016/j.ajem.2009.03.019. Epub 2010 Feb 25.
We sought to determine whether risk tolerance as measured by scales (malpractice fear scale [MFS], risk-taking scale [RTS], and stress from uncertainty scale [SUS]) is associated with decisions to admit or use computed tomography (CT) coronary angiogram and decisions to order cardiac markers in emergency department (ED) patients with chest pain. We also studied if the opening of an ED-based observation unit affected the relationship between risk scales and admission decisions.
Data from a prospective study of ED patients 30 years or older with chest pain were used. Risk scales were administered to ED attending physicians who initially evaluated them. Physicians were divided into quartiles for each separate risk scale. Fisher's exact test and logistic regression were used for statistical analysis.
A total of 2872 patients were evaluated by 31 physicians. The most risk-averse quartile of RTS was associated with higher admission rates (78% vs 68%) and greater use of cardiac markers (83% vs 78%) vs the least risk-averse quartile. This was not true for MFS or SUS. Similar associations were observed in low-risk patients (Thrombolysis in Myocardial Infarction risk score of 0 or 1). The observation unit was not associated with a higher admission rate and did not modify the relationship between risk scales and admission rates.
The RTS was associated with the decision to admit or use computed tomography coronary angiogram, as well as the use of cardiac markers, whereas the MFS and SUS were not. The observation unit did not affect admission rates and nor did it affect how physician's risk tolerance affects admission decisions.
我们旨在确定通过量表（医疗事故恐惧量表[MFS]、风险承受量表[RTS]和不确定性应激量表[SUS]）测量的风险承受能力是否与接受或使用计算机断层扫描（CT）冠状动脉造影的决策以及在急诊科（ED）胸痛患者中是否使用心脏标志物的决策相关。我们还研究了 ED 观察单元的开放是否会影响风险量表与入院决策之间的关系。
使用前瞻性研究的 ED 患者 30 岁或以上胸痛患者的数据。风险量表分发给最初评估患者的 ED 主治医生。医生根据每个单独的风险量表分为四分之一。Fisher 精确检验和逻辑回归用于统计分析。
共有 2872 名患者由 31 名医生进行评估。RTS 的最避险四分位数与更高的入院率（78%对 68%）和更高的心脏标志物使用率（83%对 78%）相关，而不是最不避险四分位数。MFS 或 SUS 则不然。在低危患者（心肌梗死溶栓治疗风险评分 0 或 1）中也观察到类似的关联。观察单元与较高的入院率无关，也不会改变风险量表与入院率之间的关系。
RTS 与接受或使用 CT 冠状动脉造影以及使用心脏标志物的决策相关，而 MFS 和 SUS 则不然。观察单元不会影响入院率，也不会影响医生的风险承受能力如何影响入院决策。
