Radiation exposure from imaging tests in pediatric emergency medicine: a survey of physician knowledge and risk disclosure practices.
BACKGROUND
Disclosing potential future malignancy risks from diagnostic tests that expose children to ionizing radiation in the emergency department may be challenging.


OBJECTIVE
We determined the proportion of pediatric emergency medicine (PEM) physicians who are aware of current malignancy risk estimates associated with head computed tomography (CT). We also examined reported risk and strategy disclosure practice patterns.


METHODS
We conducted an online survey of members of a national Canadian PEM physician association using a modified Dillman's technique.


RESULTS
Of 156 eligible participants, 126 (80.8%) responded to the survey. Of the 126 respondents, 124 (98.4%; 95% confidence interval [CI] 96.2-100) reported that there is a potential malignancy risk associated with head CT, and 46 (36.5%; 95% CI 28.1-44.9) correctly identified the best current estimate of this risk. The majority, 68.8% (95% CI 60.7-76.9), reported disclosing these possible risks "most of the time/almost always." Although some physicians reported varying their strategy with the clinical scenario, the most frequently selected disclosure strategies were a comparison with chest radiographs and everyday risks. Frequently cited barriers to informed risk-benefit discussions were concerns that parents will worry excessively about cancer (27.8%), discussions during the treatment of a critically ill child (23.8%), and a concern that parents may not want the test (15.9%).


CONCLUSIONS
Approximately one-third of pediatric emergency physicians were able to identify the best available estimate of the malignancy risk from a head CT. Although there are some barriers, many PEM physicians report regularly participating in risk-benefit disclosures.
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Kathy
K
Boutis
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Jason
J
Fischer
Sections of Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
Stephen B
SB
Freedman
Department of Diagnostic Imaging, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada.
Karen E
KE
Thomas
D002170:Canada; D003142:Communication; D004635:Emergency Medicine; D006257:Head / Q000000981:diagnostic imaging; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009369:Neoplasms / Q000209:etiology*; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011829:Radiation Dosage; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*; D014342:Truth Disclosure
child; computed tomography; management; radiation