title: Physician Risk Tolerance and Head Computed Tomography Use for Patients with Isolated Headaches.
abstract: BACKGROUND
  Headaches are one of the most common afflictions in adults and reasons for emergency department (ED) visits.
  
  
  OBJECTIVE
  We sought to determine the association between physician risk tolerance and head computed tomography (CT) use in patients with headaches in the ED.
  
  
  METHODS
  We performed a retrospective study of patients with nontraumatic isolated headaches in the ED and then administered two instruments (Risk-Taking subscale [RTS] of the Jackson Personality Index and a Malpractice Fear Scale [MFS]) to attending physicians who had evaluated these patients and made decisions regarding head CT scans. Outcomes were head CT use during ED evaluation and hospital admission. A hierarchical logistic regression was used to determine the effect of risk scales on head CT use.
  
  
  RESULTS
  Of the 1328 patients with headaches, 521 (39.2%) received brain CTs and 83 (6.9%) were admitted; 33 (2.5%) patients received a final diagnosis that the central nervous system was the origin of the disease. Among the 17 emergency physicians (EPs), the median of the MFS and RTS was 23 (interquartile range [IQR] 19-25) and 21 (IQR 20-23), respectively. EPs who were relatively risk-averse and those who possessed a higher level of malpractice fear were not more likely to order brain CTs for patients with isolated headaches.
  
  
  CONCLUSIONS
  Individual EP risk tolerance, as measured by RTS, and malpractice concerns, measured by MFS, were not predictive of CT use in patients with isolated headaches.
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung County, Taiwan.
authors.forename: Yi-Syun
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung County, Taiwan.
authors.forename: Yuan-Jhen
authors.initials: YJ
authors.lastname: Syue
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung County, Taiwan.
authors.forename: Yung-Lin
authors.initials: YL
authors.lastname: Yen
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung County, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung County, Taiwan.
authors.forename: Yu-Ni
authors.initials: YN
authors.lastname: Ho
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung County, Taiwan.
authors.forename: Fu-Jen
authors.initials: FJ
authors.lastname: Cheng
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006261:Headache / Q000175:diagnosis*; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008318:Malpractice / Q000145:classification; D008875:Middle Aged; D010820:Physicians / Q000523:psychology* / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*
keywords: computed tomography; emergency medicine; headache; risk tolerance