We appreciate the comments made by Dr. Platz-Mills and Mr. Keil regarding our recent study evaluating the use of delayed telephone consent in emergency medicine research and the recognition of our high rate of successful telephone follow-up.[1] Several specific factors likely contribute to our success. Our team made up to six telephone attempts for enrolled patients, which is more than other studies with less success.[2, 3] In addition, the majority of our enrolled patients were elderly (mean ± SD age = 75.8 ± 12.2 years). Elderly patients are inherently more stable geographically and potentially easier to contact as many are retired. It is noteworthy that the telephone follow-up rate for elderly patients (65 years and older) in the study by Dr. Platz-Mills was actually 100%.[4] We recognize, however, that our follow-up rate may not be generalizable to other populations.

In their letter, Dr. Platz-Mills and Mr. Keil, however, misinterpreted a portion of our methodology. Dr. Platz-Mills and Mr. Keil state, “When we used similar methods to that of Offerman et al. (i.e., making calls to patients using information from the ED record), only about 50% of patients or surrogates were contacted.” We explicitly state in the original manuscript that “Eligible patients were identified by on-duty emergency physicians who completed standardized data collection forms. Data collected from the index ED visit included patient demographics and clinical information.”[1] During this process, the patient's telephone number was collected, and we recommend specifically collecting follow-up telephone numbers during the ED visit.

We agree with Dr. Platz-Mills and Mr. Keil that the use of a delayed consent format is not ethical or practical for a small subset of observational studies. For studies addressing sensitive subjects (sexually transmitted diseases, substance abuse, etc.), in-person ED consent is likely more appropriate. Such determination is up to the investigators and their local institutional review board. However, for most observational, minimal-risk studies, delayed telephone consent is ethical, feasible, and recommended.


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