title: Patient preferences and acceptable risk for computed tomography in trauma.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, The University of California San Francisco, San Francisco, CA, USA. Electronic address: Robert.rodriguez@emergency.ucsf.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rodriguez
authors.affiliation: Department of Emergency Medicine, The University of California San Francisco, San Francisco, CA, USA.
authors.forename: Tarann M
authors.initials: TM
authors.lastname: Henderson
authors.affiliation: Department of Emergency Medicine, The University of California San Francisco, San Francisco, CA, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Ritchie
authors.affiliation: Department of Emergency Medicine, University of California Irvine, Irvine, CA, USA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Langdorf
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Silverman
authors.affiliation: Department of Emergency Medicine, University of California Irvine, Irvine, CA, USA.
authors.forename: Joelle
authors.initials: J
authors.lastname: Schlang
authors.affiliation: Department of Emergency Medicine, University of California Irvine, Irvine, CA, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Sloane
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Ronan
authors.affiliation: Department of Emergency Medicine, University of California Irvine, Irvine, CA, USA.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000191:economics / Q000523:psychology; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Acceptable risk; Patient preferences; Radiation risk; Trauma CT; Trauma imaging