Purpose

Sexually transmitted infections (STIs) are disproportionally prevalent in adolescents, and adolescents often present to the pediatric emergency department (PED) for STI care. Prior studies have found low rates of sexual history documentation and STI testing in the PED. However, these studies have had limited sample sizes because of the burden of manual chart review. We aimed to estimate the rate of sexual history documentation and identify factors associated with STI testing in a large cohort of adolescents using natural language processing (NLP).

Methods

We applied a validated NLP algorithm to all adolescent visits over a three-year period to the PED at a single large children's health care organization with a chief complaint potentially related to an STI. We utilized NLP to determine the prevalence of sexual history documentation in these patients. We applied logistic regression models to determine associations between sexual history documentation, patient demographic factors, and STI testing.

Results

Of the 1,987 patient encounters included, only 56% had a sexual history documented, and only 40% of all patients were tested for STIs. Patients were more likely to have a sexual history documented and to be tested for STIs if they were of non-Hispanic black race/ethnicity, were >15 years of age, and had nonprivate insurance. Patients with a sexual history documented were seven times more likely to have STI testing ordered. Of patients tested (n = 728), 25% were positive for an STI.

Conclusions

Despite presenting to the PED with symptoms potentially related to an STI, many adolescents are not receiving recommended sexual health care. Rates of sexual history documentation and STI testing varied by demographic factors including race, age, and insurance status. Utilizing NLP technology allowed us to examine a larger sample size than previously documented in the adolescent sexual history and PED literature. This study highlights critical opportunities to improve sexual health provision and equity of care provided in the PED.

中文翻译：

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儿科急诊科错过性史记录和性传播感染检测的机会

目的

性传播感染 (STI) 在青少年中非常普遍，青少年经常到儿科急诊科 (PED) 接受 STI 护理。先前的研究发现，PED 中性病史记录和 STI 检测的比率较低。然而，由于人工图表审查的负担，这些研究的样本量有限。我们旨在使用自然语言处理 (NLP) 在大量青少年中估计性史记录的比率并确定与 STI 测试相关的因素。

方法

我们将经过验证的 NLP 算法应用于三年期间在一家大型儿童保健组织的 PED 的所有青少年就诊，其主要投诉可能与性传播感染有关。我们利用 NLP 来确定这些患者中性史记录的流行程度。我们应用逻辑回归模型来确定性史记录、患者人口统计因素和 STI 检测之间的关联。

结果

在包括的 1,987 名患者中，只有 56% 的患者有性病史，只有 40% 的患者接受了性传播感染检测。如果患者是非西班牙裔黑人种族/族裔、年龄 > 15 岁并且有非私人保险，则他们更有可能记录性病史并接受 STI 检测。记录有性病史的患者接受 STI 检测的可能性是其 7 倍。在接受测试的患者（n = 728）中，25% 的 STI 呈阳性。

结论

尽管向 PED 提出可能与 STI 相关的症状，但许多青少年并未接受推荐的性保健服务。性史记录和 STI 检测的比率因人口因素（包括种族、年龄和保险状况）而异。利用 NLP 技术，我们可以检查比以前在青少年性史和 PED 文献中记录的更大的样本量。本研究强调了改善 PED 提供的性健康服务和公平护理的关键机会。