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Parents' Utilities for Outcomes of Occult Bacteremia
Jonathan E. Bennett, MD;
Walton Sumner II, MD;
Stephen M. Downs, MD, MS;
David M. Jaffe, MD
Arch Pediatr Adolesc Med. 2000;154:43-48.
Objective To describe parents' values for outcomes of occult bacteremia using utility assessment, a quantitative method that incorporates risk preference.
Design Computer-based utility assessment interview.
Setting Urban children's hospital pediatric emergency department with 50,000 visits annually.
Participants Convenience sample of parents presenting with a child between 3 and 36 months.
Main Outcome Measure 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 utilities were 0.9974 for blood drawing, 0.9941 for local infection, 0.9921 for hospitalization, 0.9768 for meningitis with recovery, 0.8611 for deafness, 0.7393 for minor brain damage, 0.3903 for severe brain damage, and 0.0177 for death. All values were significantly different from those that immediately preceded and succeeded (P<.0001), except for local infection vs hospitalization (P = .14). Median utilities for blood drawn, local infection, and hospitalization were 1. There were no significant differences among utilities of parents who presented with a febrile child (temperature  39°C), or an afebrile child (temperature <39°C). There were also no significant differences among utilities regardless of whether parents had children with prior experience with the outcomes.
Conclusions Assessment of utilities for outcomes of occult bacteremia yielded extremely high mean and median values for outcomes without permanent sequelae. This suggests that parents presenting to an emergency department may rationally prefer painful transient experiences, including venipuncture, for their children rather than risk even rare chances of severe outcomes.
From the Departments of Pediatrics (Drs Bennett and Jaffe) and Medicine (Dr Sumner), Washington University School of Medicine, St Louis, Mo; and the Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill (Dr Downs).
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