PROJECT SUMMARY ABSTRACT:
Candidate: Dr. Courtney Mangus is a pediatric emergency medicine (EM) physician and health services
researcher at the University of Michigan (U-M) Medical School. She is interested in identifying and testing ways
to improve diagnostic safety and patient engagement via shared decision-making (SDM) in the community
emergency department (ED) setting, which is under-resourced compared to tertiary care EDs. Her goal is to
become an independent investigator and leader in the field, improving the quality of care for children evaluated
for common pediatric conditions, such as abdominal pain, in community EDs. Research Context: The most
common pediatric surgical emergency, appendicitis, is ideally diagnosed with ultrasonography. However, 85%
of children seek care in community EDs, which often have limited resources. As such, children presenting with
abdominal pain in this setting are more likely to undergo computed tomography (CT). CT imaging is the most
sensitive diagnostic test for appendicitis, but it exposes children to ionizing radiation and ultimately increases
their risk of developing cancer. Risk stratification tools exist to help clinicians determine which children with
abdominal pain require imaging, but for the ~50% children in community EDs who fall into the group of
intermediate risk for appendicitis, clinicians often face a dilemma regarding next diagnostic steps. Data suggest
most clinicians choose either 1) CT imaging or 2) watchful waiting (observation or discharge with scheduled
follow-up). Because this dilemma is so common, a systematic, family-centered approach is needed to
communicate diagnostic options, including risks/benefits, and engage families in the decision-making process.
Development and implementation of an intervention to facilitate SDM in this scenario has the potential to
reduce unnecessary CT scans and increase family engagement in the diagnostic process. Research Aims: In
this project, Dr. Mangus will utilize an iterative, user-centered design approach to develop and refine a risk-
tailored intervention to facilitate SDM in the diagnosis of pediatric abdominal pain in the community ED setting
(Aims 1a/1b) and pilot the intervention via a randomized controlled trial of 100 ED patients presenting with
signs and symptoms of appendicitis to a community ED (Aim 2). The research will be conducted at Hurley
Medical Center (HMC), a community hospital in Flint, Michigan, which serves a large population of racial/ethnic
minority and low-income children (AHRQ priority populations). Career Development Plan: Dr. Mangus will
undertake the proposed research plan under the expert mentorship of Drs. Mahajan, Manojlovich, Schoenfeld
and Singh. Her career development curriculum is focused on mixed methods research, training in SDM
intervention development, and clinical trial methodology. The proposal utilizes the resources of the U-M
Department of EM, U-M’s Center for Bioethics and Social Sciences in Medicine, the U-M Institute for
Healthcare Policy and Innovation, and HMC. In alignment with the mission of AHRQ, Dr. Mangus’ long-term
goals are to improve patient-centered care and diagnostic safety for children requiring emergency care.
