Pregnant adolescents in the emergency department: Diagnosed and not diagnosed

Causey, Alan L.; Seago, Karen; Wahl, Nancy G.; Voelker, Cynthia L

doi:10.1016/s0735-6757(97)90081-4

Cited by 10 publications

(4 citation statements)

References 18 publications

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“…In our study, we found that even among patients who presented with potential reproductive health complaints, fewer than half were tested for pregnancy. This finding is concerning given previous studies demonstrating the high frequency (40%) of presentations with abdominal or genitourinary complaints among adolescents eventually diagnosed as pregnant, whose pregnancies were initially missed in the ED . Givens and colleagues found that among adolescents diagnosed with pregnancy in the ED, 80% presented with gastrointestinal or genitourinary complaints, but only 8% of the patients requested pregnancy testing or mentioned the possibility of pregnancy to the triage nurse.…”

Section: Discussionmentioning

confidence: 91%

“…The diagnosis or exclusion of pregnancy and its complications is critical during ED evaluation of many females of child‐bearing age, but particularly among adolescent patients . Adolescents often present late in their first trimester for pregnancy diagnosis, and earlier pregnancy detection may help reduce some of the adverse sequelae associated with adolescent pregnancies, such as preeclampsia, prematurity, and fetal and maternal death .…”

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confidence: 99%

“…Given the importance of detecting pregnancies during the ED evaluations of adolescent females, it is necessary to understand current pregnancy testing patterns. Although single‐center studies have found that the diagnosis of pregnancy in adolescents is often missed on initial ED evaluation, national figures have yet to be estimated. Therefore, we sought to measure the frequency of pregnancy testing among a nationally representative sample of adolescent female ED visits and to determine factors associated with pregnancy testing.…”

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confidence: 99%

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Frequency of Pregnancy Testing Among Adolescent Emergency Department Visits

et al. 2013

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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.

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Section: Discussionmentioning

confidence: 91%

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confidence: 99%

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confidence: 99%

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Frequency of Pregnancy Testing Among Adolescent Emergency Department Visits

et al. 2013

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“…The pregnancy status of female patients presenting for radiation therapy is not always known. Unfortunately, patient history alone is not reliable for determining the possibility of pregnancy [1][2][3][4][5][6][7][8]. In 1975, Laubach and Wilchins recommended that a pregnancy test be performed on any female of childbearing age before diagnostic or therapeutic interventions to avoid potentially teratogenic complications and miscarriage [9,10].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey

Zaki¹,

Zhu²,

Mackley³

et al. 2021

ecancer

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Background:The human embryo or foetus is susceptible to harmful effects of radiation, which include growth delay, malformations, impaired cognitive function, cancer and foetal demise. The purpose of this study is to describe pregnancy screening practices in radiation oncology, so that potential health effects may be avoided and areas of prevention may be identified.Methods: An electronic survey was delivered to 6,304 members of the American Society for Radiation Oncology. The survey subjects were radiation oncologists who are currently practicing in the world. Chi-square tests and a multiple logistic regression model were used to analyse the data. All tests were two-sided and the statistical significance level used was 0.05. This study (STUDY00009765) was approved by an Institutional Review Board.Results: A total of 434 responses from practicing radiation oncologists were received. Of these respondents, 69.1% were practicing in the United States. Of all respondents, 19.8% reported treating paediatric patients and 93.6% reported treating premenopausal patients. Despite 84.8% of radiation oncologists saying they would 'strongly agree' or 'agree' that one should screen for pregnancy prior to radiation therapy, 29.7% of respondents reported their department has no screening policy and 7.1% of respondents reported they do not screen for pregnancy. Having a departmental policy was associated with screening for pregnancy (p-value = 0.0005).Of all respondents, 93 reported treating a known pregnant patient. Of these 93 respondents, 76 reported intentionally treating and 17 reported accidentally treating a pregnant patient. Respondents who did not screen at time of simulation were significantly more likely to treat a pregnant patient than those who screened at time of simulation (p-value = 0.0459). Conclusions:Heterogeneity exists among practicing radiation oncologists regarding pregnancy screening. Institutional policies should be clear and consistent. All members of the radiation oncology team should make every effort to minimise unintended radiation exposure to the embryo or foetus.

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