Frequency of Pregnancy Testing Among Adolescent Emergency Department Visits

Abstract

Objective To estimate the frequency of pregnancy testing among adolescent emergency department (ED) patients and to determine factors associated with testing. Methods This was a retrospective cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005-2009 of ED visits by females ages 14 to 21 years. We estimated the frequency of pregnancy testing among all visits, those for potential reproductive health complaints, and those associated with exposure to potentially teratogenic radiation. Multivariable logistic regression modeling was performed to calculate adjusted probabilities and odds ratios with 95% confidence intervals to evaluate factors associated with pregnancy testing by patient characteristics. Results We identified 11,531 visits, representing an estimated 41.0 million female adolescent ED visits. Of these, 20.9% (95% CI 19.3%, 22.5%) included pregnancy testing. Among visits for potential reproductive health complaints and those associated with exposure to potentially teratogenic radiation, 44.5% (95% CI 41.3%, 47.8%) and 36.7% (95% CI 32.5%, 40.9%), respectively, included pregnancy testing. Among the entire study population, we found statistically significant differences in pregnancy by testing (p<0.001 for all) by age, race/ethnicity, hospital admission, and geographic region. Conclusions A minority of female adolescent ED visits included pregnancy testing even if patients presented with potential reproductive health complaints or received exposure to ionizing radiation. Small but statistically significant differences in pregnancy testing rates were noted based on age, race/ethnicity, ED disposition, and geographic region. Future studies should focus on designing quality improvement interventions to increase pregnancy testing in adolescent ED patients, especially among those in whom pregnancy complications or the risk of potentially teratogenic radiation exposure is higher.

Low rates of pregnancy screening in adolescents before teratogenic exposures in a national sample of children's hospitals

“…12 Although these guidelines exist, one study suggests that adolescents exposed to computed tomography (CT) radiation have lower than expected rates of pregnancy screening. 13 This study has not been confirmed by other reports.…”

“…Variation in pregnancy screening existed not only between hospitals but also within a hospital by cohort type (ALL, AML, and ER). Although earlier studies suggested regional variation in pregnancy screening 13,21 and practice variation across centers has also been described for supportive-care measures such as analgesia administration in pediatric cancer patients, 22,23 to our knowledge, no prior reports have demonstrated different intracenter practice variation in pregnancy screening. Future work should focus on elucidating the factors responsible for both intercenter and intracenter variation in pregnancy screening, such as academic hospital status, hospital volume, affiliation with an adult hospital, and hospital environment (urban vs rural).…”

“…Although previously reported in the literature, the low rate of pregnancy screening in adolescents before abdominal radiation exposure was surprising. A study by Goyal et al 13,20 found that only 37% of adolescents were screened for pregnancy before CT and that the proportions of pregnancy screening in women of reproductiveage exposed to teratogenic medications in the ER setting were low. Our work corroborates these findings in a larger, more contemporary patient sample with a more inclusive adolescent age range.…”

Practice Pattern Variation in the Care of Children With Acute Asthma

“…Our independent variable was ED type. A pediatric ED was defined as an ED with >75% of visits made by patients ≤21 years old . Other EDs were considered general EDs.…”

Motivational Interviewing for Adolescents in the Emergency Department

“…Good communication with ED providers and administrators was critical to problem recognition and resolution. Because many ED clinicians are reluctant to provide sexual health care or provide suboptimal care, [21][22][23] we used a dedicated health educator to deliver the intervention. We obtained funds to pay for this position for a limited time; but this may not be possible at many sites, and funding this position is a barrier to sustainability.…”