Radiation exposure from imaging tests in pediatric emergency medicine: a survey of physician knowledge and risk disclosure practices

Abstract

Background: Disclosing potential future malignancy risks from diagnostic tests that expose children to ionizing radiation in the emergency department may be challenging.

Objectives: 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.

Keywords: child; computed tomography; management; radiation.