Shared Decision Making in the Emergency Department: Development of a Policy-Relevant Patient-Centered Research Agenda

Abstract

A 6-year-old otherwise healthy girl is brought to the emergency department (ED) by her parents after waking up at 3 a.m. saying that her tummy hurts. She had not eaten dinner the evening before because of stomach pain, but seemed better after being given acetaminophen and falling asleep in her bed. She has not vomited and has had no diarrhea, though when asked where she hurts she points to her periumbilical region. On examination, she is interactive and appears well, has normal vital signs, and is afebrile. She is mildly tender in the periumbilical region and right lower quadrant without guarding or rebound tenderness and otherwise has a normal examination. The clinician communicates her concern for appendicitis with the parents and patient and orders ibuprofen and a focused right lower quadrant ultrasound. Approximately 1 hour later, imaging results are available and indicate that the appendix was not visualized. The patient is re-examined. She says she feels better, her abdominal pain is nearly gone, and there is only mild residual tenderness to deep palpation in the periumbilical region and both lower quadrants.

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