title: A survey of emergency physicians' fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma.
abstract: OBJECTIVE
  The objective of the study was to determine whether fear of malpractice is associated with emergency physicians' decision to order head computed tomography (CT) in 3 age-specific scenarios of pediatric minor head trauma. We hypothesized that physicians with higher fear of malpractice scores will be more likely to order head CT scans.
  
  
  METHODS
  Board-eligible/board-certified members of the Michigan College of Emergency Physicians were sent a 2-part survey consisting of case scenarios and demographic questions. Effect of fear of malpractice on the decision to order a CT scan was evaluated using a cumulative logit model.
  
  
  RESULTS
  Two hundred forty-six members (36.5%) completed the surveys. In scenario 1 (infant), being a male and working in a university setting were associated with reduced odds of ordering a CT scan (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.18-0.88; and OR, 0.35; 95% CI, 0.13-0.96, respectively). In scenario 2 (toddler), working for 15 years or more, at multiple hospitals, and for a private group were associated with reduced odds of ordering a CT scan (OR, 0.46; 95% CI, 0.26-0.79; OR, 0.36; 95% CI, 0.16-0.80; and OR, 0.51; 95% CI, 0.27-0.94, respectively). No demographic variables were significantly associated with ordering a CT scan in scenario 3 (teen). Overall, the fear of malpractice was not significantly associated with ordering a CT scan (OR, 1.28; 95% CI, 0.73-2.26; and OR, 1.70; 95% CI, 0.97-3.0). Only in scenario 2 was high fear significantly associated with increased odds of ordering a CT scan (OR, 2.09; 95% CI, 1.08-4.05).
  
  
  CONCLUSIONS
  Members of Michigan College of Emergency Physicians with a higher fear of malpractice score tended to order more head CT scans in pediatric minor head trauma. However, this trend was shown to be statistically significant only in 1 case and not overall.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109-0305, USA. andrewcw@med.umich.edu
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Wong
authors.forename: Terry
authors.initials: T
authors.lastname: Kowalenko
authors.forename: Stephanie
authors.initials: S
authors.lastname: Roahen-Harrison
authors.forename: Barbara
authors.initials: B
authors.lastname: Smith
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Maio
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Stanley
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003657:Decision Making; D004635:Emergency Medicine / Q000592:standards*; D005239:Fear; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008297:Male; D008318:Malpractice; D008824:Michigan; D016017:Odds Ratio; D010820:Physicians / Q000523:psychology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000592:standards*