TY - JOUR
T1 - Impairment and severity
T2 - how ED physicians decide to override an impaired patient's refusal
AU - Withers, Elizabeth
AU - Sklar, David P.
AU - Crandall, Cameron S.
PY - 2008/9
Y1 - 2008/9
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ajem.2007.10.033
DO - 10.1016/j.ajem.2007.10.033
M3 - Article
C2 - 18774048
AN - SCOPUS:50549091753
SN - 0735-6757
VL - 26
SP - 803
EP - 807
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 7
ER -