Parents' utilities for outcomes of occult bacteremia

Objective: To describe parents' values for outcomes of occult bacteremia us ing utility assessment, a quantitative method that incorporates risk prefer ence. Design: Computer-based utility assessment interview. Setting: Urban children's hospital pediatric emergency department with 50 0 00 visits annually. Participants: Convenience sample of parents presenting with a child between 3 and 36 months. Main Outcome Measurer Parents' utility values for 8 outcomes from treatment of occult bacteremia: blood drawing, localized infection, hospitalization for antibiotics, meningitis with recovery, meningitis resulting in deafness , minor brain damage, severe brain damage, and death. Results: Ninety-four subjects successfully completed the interview. Mean ut ilities were 0.9974 for blood drawing, 0.9941 for local infection, 0.9921 f or hospitalization, 0.9768 for meningitis with recovery, 0.8611 for deafnes s, 0.7393 for minor brain damage, 0.3903 for severe brain damage, and 0.017 7 for death. All values were significantly different from those that immedi ately preceded and succeeded (P<.0001), except for local infection vs hospi talization (P = .14). Median utilities for blood drawn, local infection, an d hospitalization were 1. There were no significant differences among utili ties of parents who presented with a febrile child (temperature greater tha n or equal to 39 degrees C), or an afebrile child (temperature <39 degrees C). There were also no significant differences among utilities regardless o f whether parents had children with prior experience with the outcomes. Conclusions: Assessment of utilities for outcomes of occult bacteremia yiel ded extremely high mean and median values for outcomes without permanent se quelae. This suggests that parents presenting to an emergency department ma y rationally prefer painful transient experiences, including venipuncture, for their children rather than risk even rare chances of severe outcomes.