ArticleResearch and practice in thrombosis and haemostasis2026
Designing a web-based factorial survey experiment on diagnostic evaluation of cardiovascular symptoms in emergency care.
Article in Research and practice in thrombosis and haemostasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Guidelines describe evidence-based diagnostic testing strategies for patients with suspected pulmonary embolism (PE), yet there is sparse empirical literature on how clinicians decide whether to suspect PE. Objectives: Our goal was to design a valid and reliable approach to assess how patients' demographics, symptoms, and risk factors impact clinicians' decisions to pursue PE testing. Methods: We designed and conducted early-stage validation of an online factorial survey experiment featuring 7 vignettes of hypothetical adult emergency department (ED) patients with cardiopulmonary symptoms. Using a 2 × 2 × 2 factorial design, we generated 8 versions of each vignette that differed by patient gender (woman/man), race (Black/White), and a case-specific clinical factor. In each vignette, participants rated their suspicion for PE and other cardiovascular conditions using a visual analog scale and indicated diagnostic tests they would order. Participants were not informed of the study design. We measured test-retest reliability in 16 physicians from 4 EDs and conducted pilot testing at a large national conference of ED clinicians. Results: Visual analog scale scores for perceived PE risk demonstrated high test-retest reliability (Pearson Conclusion: These pilot data provide preliminary support for the validity and reliability of using an online factorial survey with clinical vignettes to experimentally assess ED clinicians' perceptions of PE risk and decisions for PE diagnostic testing.
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