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17 - Medical Decision-Making in the Emergency Department: Balancing the Patient’s Health with the Clinician’s Perception of Risk

from Section 1 - Decision-Making

Published online by Cambridge University Press:  14 March 2025

By
Michael Weinstock
Edited by
Alex Koyfman  and
Brit Long
Alex Koyfman
Affiliation:
University of Texas Southwestern Medical Center
Brit Long
Affiliation:
San Antonio Military Medical Center
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Summary

This delicate balancing act plays out across the country each day with practice variation regarding ED testing, management, and disposition decisions. Consider the HEART score, where ACEP guidelines recommend an “acceptable miss rate” of 1–2%, specifically stating that trying to get lower than this may cause patient harm from false positive results. However, emergency clinicians have a different take, with surveys prior to the ACEP statement showing we are only comfortable with a miss rate of 0.1% or 0.01%. There are many such examples where the “cure” might be worse than the “disease,” including the PECARN criteria for pediatric head injury with the decision rule approaching a 100% sensitivity for a “clinically important traumatic brain injury,” which is a level so low that it is thought to be lower than the risk of CT-induced malignancies resulting from the radiation associated with testing.

Type
Chapter
Information
Emergency Medicine Thinker
Pearls for the Frontlines
 , pp. 124 - 138
Publisher: Cambridge University Press
Print publication year: 2025

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References

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