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{
    "pk": 11426,
    "title": "Computed Tomography Risk Disclosure in the Emergency Department: A Survey of Pediatric Emergency Medicine Fellowship Program Leaders",
    "subtitle": null,
    "abstract": "Introduction:\n Given the potential malignancy risks associated with computed tomography (CT), some physicians are increasingly advocating for risk disclosure to patients/families.Objective: Our goal was to evaluate the practices and attitudes of pediatric emergency medicine (PEM) fellowship program leaders’ regarding CT radiation-risk disclosure.\nMethods:\n We conducted a cross-sectional survey study of U.S. and Canadian PEM fellowship directors and associate/assistant directors. We developed a web-based survey using a modified Dillman technique. Primary outcome was the proportion who “almost always” or “most of the time” discussed potential malignancy risks from CT prior to ordering this test.\nResults:\n Of 128 physicians who received the survey, 108 (86%) responded. Of those respondents, 73%, 95% confidence interval (CI) [64-81] reported “almost always” or “most of the time” discussing potential malignancy risks when ordering a CT for infants; proportions for toddlers, school-age children, and teenagers were 72% (95% CI [63-80]), 66% (95% CI [56-75]), and 58% (95% CI [48-67]), respectively (test for trend, p=0.008). Eighty percent reported being “extremely” or “very” comfortable discussing radiation risks. Factors of “high” or “very high” importance in disclosing risks included parent request for a CT not deemed clinically indicated for 94% of respondents, and parent-initiated queries about radiation risks for 79%. If risk disclosure became mandatory, 82% favored verbal discussion over written informed consent.\nConclusion:\n PEM fellowship program leaders report frequently disclosing potential malignancy risks from CT, with the frequency varying inversely with patient age. Motivating factors for discussions included parental request for a CT deemed clinically unnecessary and parental inquiry about risks.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Radiation risk"
        },
        {
            "word": "Consent"
        },
        {
            "word": "disclosure"
        },
        {
            "word": "computed tomography"
        },
        {
            "word": "emergency department"
        }
    ],
    "section": "Pediatrics",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/88s4k8kd",
    "frozenauthors": [
        {
            "first_name": "Jennifer",
            "middle_name": "R.",
            "last_name": "Marin",
            "name_suffix": "",
            "institution": "University of Pittsburgh School of Medicine, Department of Pediatrics and Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Karen",
            "middle_name": "E.",
            "last_name": "Thomas",
            "name_suffix": "",
            "institution": "University of Toronto, Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, Ontario, Canada",
            "department": "None"
        },
        {
            "first_name": "Angela",
            "middle_name": "M.",
            "last_name": "Mills",
            "name_suffix": "",
            "institution": "University of Pennsylvania, Perelman School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Kathy",
            "middle_name": "",
            "last_name": "Boutis",
            "name_suffix": "",
            "institution": "University of Toronto, Hospital for Sick Children, Division of Emergency Medicine, \nToronto, Ontario, Canada",
            "department": "None"
        }
    ],
    "date_submitted": "2017-10-27T23:44:39Z",
    "date_accepted": "2017-10-27T23:44:39Z",
    "date_published": "2018-06-04T20:51:47Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11426/galley/6186/download/"
        }
    ]
}