Physicians' attitudes toward misdiagnosis of pulmonary embolism: A utilityanalysis

Rationale and Objectives, The purpose of this study was to measure physicia ns' utilities for outcomes after ventilation -perfusion lung scanning and t o explore physicians' attitudes toward misdiagnosis and the treatment of pa tients suspected of having pulmonary embolism (PE) in a quantitative manner by using a utility analysis. Materials and Methods. Before ordering lung scanning for suspected PE, phys icians rated five possible outcomes on a scale of 0-100 by using a computer order-entry system, These responses were rescaled and transformed to a uti lity measure by using the Torrance transformation. Results, The mean utility for the potential outcomes,after 341 lung scans w ere (a) no PE and no treatment (true-negative, 93 +/- 22 [mean +/- standard deviation]), (b) PE with appropriate treatment (true-positive, 84 +/- 24), (c) no PE but patient received treatment (false-positive, 54 +/- 32), (d) PE but patient did not receive treatment (false-negative, 14 +/- 23), and ( e) death during pulmonary angiography (2 +/- 11). After lung scanning for a cute PE, physicians placed greatest value on excluding the diagnosis (true- negative). Providing unnecessary treatment (false-positive) was valued in t he midrange of utilities. The value of missing PE (false-negative) was rate d almost equal to that of dying during pulmonary angiography. Conclusion. Physicians consider providing treatment for PE without objectiv e confirmation of an embolus to be preferable to missing a case of PE.