title: Impairment and severity: how ED physicians decide to override an impaired patient's refusal.
abstract: We attempted to identify the contributions of impairment and illness severity in the decision to treat a patient who refuses treatment using case vignettes. We constructed 4 emergency department (ED)-based case vignettes of adults with varied impairment and illness severity who each refused care. Clinician used a 100-mm visual analog scale (VAS) to assess patient impairment, illness severity, and their willingness to override a patient's refusal (WOPR) of treatment. We used correlation and logistic regression to assess the contributions of impairment and illness severity on WOPR. Thirty-seven ED physicians participated. Increasing impairment (r = 0.80) and illness severity (r = 0.81) correlated with WOPR, and an increase of 10 mm of impairment on the VAS (odds ratio, 2.1; 95% confidence interval, 1.5-3.0) and an increase of 10 mm of severity (odds ratio, 1.5; 95% confidence interval, 1.2-2.0) independently predicted a WOPR. Both degrees of impairment and illness severity impact an ED physician's WOPR.
authors.affiliation: Department of Emergency Medicine, MSC10 5560, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Withers
authors.forename: David P
authors.initials: DP
authors.lastname: Sklar
authors.forename: Cameron S
authors.initials: CS
authors.lastname: Crandall
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003657:Decision Making; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010819:Physician's Role; D012720:Severity of Illness Index; D016312:Treatment Refusal