Impairment and severity: how ED physicians decide to override an impaired patient's refusal

Elizabeth Withers, David P. Sklar, Cameron S. Crandall

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

We attempted to identify the contributions of impairment and illness severity in the decision to treat a patient who refuses treatment using case vignettes. We constructed 4 emergency department (ED)-based case vignettes of adults with varied impairment and illness severity who each refused care. Clinician used a 100-mm visual analog scale (VAS) to assess patient impairment, illness severity, and their willingness to override a patient's refusal (WOPR) of treatment. We used correlation and logistic regression to assess the contributions of impairment and illness severity on WOPR. Thirty-seven ED physicians participated. Increasing impairment (r = 0.80) and illness severity (r = 0.81) correlated with WOPR, and an increase of 10 mm of impairment on the VAS (odds ratio, 2.1; 95% confidence interval, 1.5-3.0) and an increase of 10 mm of severity (odds ratio, 1.5; 95% confidence interval, 1.2-2.0) independently predicted a WOPR. Both degrees of impairment and illness severity impact an ED physician's WOPR.

Original languageEnglish (US)
Pages (from-to)803-807
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume26
Issue number7
DOIs
StatePublished - Sep 2008
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine

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