Application of informed consent principles in the emergency department evaluation of febrile children at risk for occult bacteremia

Abstract

Informed consent requires that the risks and benefits of a particular diagnostic and therapeutic plan be reviewed with the patient, including the disclosure of alternative diagnostic and treatment approaches. Although it could be argued that it is difficult to present all the diagnostic and therapeutic options to parents in the E.D. management of febrile children at risk for occult bacteremia, it is the purpose of this report to describe the experience with following these principles of informed consent in a group of these children.

Methods: Convenience sample of febrile children presenting to an E.D. at risk for occult bacteremia. A standardized information sheet was presented. A parent survey of preferences followed.

Results: In 37 patients, most of the parents chose no tests and preferred to be involved in the medical decision making process for their child.

Conclusions: While preferred by parents and supported by AAP, the process of informed consent, for febrile children at risk for occult bacteremia, is time consuming and often not possible when the E.D. is busy. Physicians may find it desirable to make decisions from an informed consent perspective to a comfort level dependent on time availability, parents' comprehension ability, and individual personal practice preference.