Physicians' attitudes toward misdiagnosis of pulmonary embolism: a utility analysis.
OBJECTIVE
The purpose of this study was to measure physicians' utilities for outcomes after ventilation-perfusion lung scanning and to explore physicians' attitudes toward misdiagnosis and the treatment of patients suspected of having pulmonary embolism (PE) in a quantitative manner by using a utility analysis.


METHODS
Before ordering lung scanning for suspected PE, physicians rated five possible outcomes on a scale of 0-100 by using a computer order-entry system. These responses were rescaled and transformed to a utility measure by using the Torrance transformation.


RESULTS
The mean utility for the potential outcomes after 341 lung scans were (a) no PE and no treatment (true-negative, 93 +/- 22 [mean +/- standard deviation]), (b) PE with appropriate treatment (true-positive, 84 +/- 24), (c) no PE but patient received treatment (false-positive, 54 +/- 32), (d) PE but patient did not receive treatment (false-negative, 14 +/- 23), and (e) death during pulmonary angiography (2 +/- 11). After lung scanning for acute PE, physicians placed greatest value on excluding the diagnosis (true-negative). Providing unnecessary treatment (false-positive) was valued in the midrange of utilities. The value of missing PE (false-negative) was rated almost equal to that of dying during pulmonary angiography.


CONCLUSIONS
Physicians consider providing treatment for PE without objective confirmation of an embolus to be preferable to missing a case of PE.
Rosen
M P
MP
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Sands
D Z
DZ
Kuntz
K M
KM
D000328:Adult; D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D003951:Diagnostic Errors; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011877:Radionuclide Imaging