Rodriguez Robert M, Henderson Tarann M, Ritchie Anne M, Langdorf Mark I, Raja Ali S, Silverman Eric, Schlang Joelle, Sloane Bryan, Ronan Clare E, Anderson Craig L, Baumann Brigitte M
Department of Emergency Medicine, The University of California San Francisco, San Francisco, CA, USA.
Department of Emergency Medicine, The University of California San Francisco, San Francisco, CA, USA.
Injury. 2014 Sep;45(9):1345-9. doi: 10.1016/j.injury.2014.03.011. Epub 2014 Mar 27.
Rising use of computed tomography (CT) to evaluate patients with trauma has increased both patient costs and risk of cancer from ionizing radiation, without demonstrable improvements in outcome. Patient-centred care mandates disclosure of the potential risks, costs and benefits of diagnostic testing whenever possible.
We sought to determine (1) patient preferences regarding emergency department (ED) real-time discussions of risks and costs of CT during their trauma evaluations; and (2) whether varying levels of odds of detection of life-threatening injury (LTI) were associated with changes in patient preferences for CT.
Excluding patients already receiving CT and patients with altered mental status, we surveyed adult, English-speaking patients at four Level I verified trauma centres. After informing subjects of cancer risks associated with chest CT, we used hypothetical scenarios with varying LTIs to assess patients' preferences regarding CT.
Of 941 patients enrolled, 50% were male and their mean age was 42 years. Most patients stated they would prefer to discuss CT radiation risks (73.5%, 95% CI [66.1-80.8]) and costs (53.2%, 95% CI [46.1-60.4]) with physicians. As the odds of detecting LTI decreased, preferences for receiving CT decreased accordingly: LTI 25% (desire 91.2%, 95% CI [89.4-93.1]), LTI 10% (desire 79.3%, 95% CI [76.7-81.9]), LTI 5% (desire 69.1%, 95% CI [66.1-72.1]) and LTI <2% (desire 53.8%, 95% CI [50.6-57.0]). If the LTI was <2% and subjects were required to pay $1000 out-of-pocket, only 34.5% (95% CI 31.4-37.5) would opt for CT.
Most non-critically injured patients prefer to discuss radiation risks and costs of CT prior to receiving imaging. As the odds of detecting LTI decrease, fewer patients prefer to have CT; at an LTI threshold of 2%, approximately half of patients would prefer to forego CT. Adding out-of-pocket costs reduced this proportion to one-third of patients.
越来越多地使用计算机断层扫描（CT）来评估创伤患者，这增加了患者的费用以及因电离辐射患癌的风险，而在治疗效果上却没有明显改善。以患者为中心的医疗要求尽可能披露诊断检查的潜在风险、费用和益处。
我们试图确定：（1）患者对于在急诊科（ED）进行创伤评估时实时讨论CT风险和费用的偏好；（2）危及生命损伤（LTI）检测几率的不同水平是否与患者对CT的偏好变化相关。
排除已接受CT检查的患者和精神状态改变的患者，我们在四个一级认证创伤中心对成年英语患者进行了调查。在告知受试者胸部CT相关的癌症风险后，我们使用具有不同LTI的假设情景来评估患者对CT的偏好。
在941名登记患者中，50%为男性，平均年龄为42岁。大多数患者表示他们更愿意与医生讨论CT辐射风险（73.5%，95%可信区间[66.1 - 80.8]）和费用（53.2%，95%可信区间[46.1 - 60.4]）。随着检测到LTI的几率降低，接受CT检查的偏好也相应降低：LTI为25%（意愿91.2%，95%可信区间[89.4 - 93.1]），LTI为10%（意愿79.3%，95%可信区间[76.7 - 81.9]），LTI为5%（意愿69.1%，95%可信区间[66.1 - 72.1]），LTI <2%（意愿53.8%，95%可信区间[50.6 - 57.0]）。如果LTI <2%且受试者需要自掏腰包支付1000美元，只有34.5%（95%可信区间31.4 - 37.5）的人会选择CT。
大多数非重伤患者更愿意在接受影像学检查之前讨论CT的辐射风险和费用。随着检测到LTI的几率降低，选择进行CT检查的患者减少；当LTI阈值为2%时，大约一半的患者会选择不做CT检查。增加自付费用将这一比例降至三分之一。
