No abstract

No abstract

Background In December 2020, an update to the CDC STI Guidelines was published for the treatment of uncomplicated Neisseria gonorrhoeae (GC) and the common co-infection of Chlamydia trachomatis (CT). These prescribing changes reflect goals of antimicrobial stewardship and antimicrobial susceptibility. Previous studies assessed guideline prescribing adherence; however, there is no current literature to assess the impact of these updates. The results will be used to further evaluate the impact of the 2021 CDC STI Treatment Guidelines on prescribing patterns in the Emergency Department (ED). Methods This study was a single-center, retrospective cohort study which included patients treated for an STI (GC/CT) in the ED at an academic medical center between February 1, 2020 and August 31, 2021, > 19 years of age, and discharged from the ED. The primary endpoint is to determine if the updated guidelines contributed to a reduced incidence of appropriate guideline directed therapy for ED treatment of STIs. Secondary endpoints include ED patients still in need of STI treatment 30-days post-ED discharge, ED patients lost to follow-up within 30 days post-ED discharge and repeat ED visit for STI within 30 days. Results A total of 1049 patient encounters were screened for inclusion with 338 patient encounters in the Pre-CDC update cohort (PRE) and 346 patient encounters in the Post-CDC update cohort (POST). Results for the primary outcome indicate a statistically significantly reduced incidence of appropriate guideline directed therapy for ED treatment of STIs (PRE = 98.2% vs POST = 62.7%, p< 0.0001). Results for the secondary outcomes were not statistically significant. Conclusion The update to the CDC STI Treatment Guidelines led to decreased guideline directed therapy prescribing in an academic medical center ED. There was no difference in ED patients still needing treatment, lost to follow-up, or repeat ED visits for STI within 30 days post ED discharge. Disclosures All Authors: No reported disclosures.

No abstract

exposures for the outcomes of ED medical imaging use (XR, CT, US, MRI, Any Imaging) among adult patients with a listed race/ethnicity in the data source. We controlled for other potential patient-level and facility-level determinants of ED imaging use in our analysis of the odds of receipt of imaging in the ED.Results: Approximately half (48.8%) of the 225,037 adult patient visits in the sample underwent ED medical imaging. 36.1% underwent XR, 16.4% CT, 4.1% US, and 0.8% MRI. White patients received ED medical imaging during 51.3% of their encounters, while black patients received imaging during 43.6% of their encounters, Asians during 50.8%, and Other race during 46% of their encounters. Hispanic patients received imaging in 45.1% of their encounters. As compared to white patients, black patients had a decreased adjusted odds of receiving imaging in the ED (OR¼ 0.87, 95% CI: 0.85-0.90). This disparity was not evident for Hispanic ethnicity nor the other analyzed racial groups. Comparatively, black patients had a much lower odds of receiving a CT scan (OR¼0.78, 95% CI: 0.75-0.81) or MRI (OR¼0.74, 95% CI: 0.65-0.85). Interestingly, Hispanic patients had a higher odds of receiving an US (OR¼1.46, 95% CI: 1.38-1.56) compared to non-Hispanic white patients. We did not note a large ethnic difference in utilization of other imaging modalities.Conclusions: We observed large racial and ethnic differences with regard to how medical imaging is used in the ED even after controlling for patient and facility-level factors. To what degree this difference is due to underuse of imaging or over-use of imaging differentially by racial and ethnic group warrants further investigation. Nonetheless, we describe in this study substantial disparities in imaging use for black adult patients in the emergency department.