Background

The objective of this study was to determine the rates at which gynecologic history and related exams are performed among adolescent females presenting with abdominal pain and whether the rates differ between patients seeking care at a pediatric compared with a general emergency department (ED).

Methods

We conducted a retrospective cohort study of female patients aged 12–21 years who presented to the ED for a chief complaint of abdominal pain at either a single academic children's ED or a single general academic ED during 2016. We examined differences in the rates of gynecologic history and related exams between institutions, before and after adjustment with inverse probability weights.

Results

A total of 837 females met the inclusion criteria for this study, and 627 patients were included in the adjusted analyses. Outcomes more commonly performed at the pediatric institution included documentation of contraception (28% at the general ED vs 43% at the pediatric ED, P < .001), sexually transmitted infection testing (32% at the general ED vs 42% at the pediatric ED, P = .04), and radiologic imaging (46% at the general ED vs 70% at the pediatric ED, P < .001). Outcomes that were more commonly performed at the general ED were pelvic exam (26% at the general ED vs 10% at the pediatric ED, P < .001) and complete blood count draw (67% at the general ED vs 39% at the pediatric ED, P < .001). No differences were observed between institutions in the documentation of menarche or sexual activity, the performance of a pregnancy test or CT scan, or the rate of subsequent ED/urgent care visits in the following year.

Conclusion

The rates at which gynecologic history and pelvic examination were performed in adolescent females presenting for abdominal pain at both a general ED and a pediatric ED were low and inconsistent. Providers should have a low threshold for testing for sexually transmitted infections and pregnancy. Pelvic examination and diagnostic lab testing should be performed when indicated in the setting of a clinically appropriate history. These efforts would ensure adequate evaluation of adolescent women and reduce unnecessary health resource utilization.

中文翻译：

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比较儿科与普通急诊科青少年女性腹痛的评估

背景

本研究的目的是确定在出现腹痛的青春期女性中进行妇科病史和相关检查的比率，以及与普通急诊科 (ED) 相比，在儿科寻求护理的患者之间的比率是否存在差异。

方法

我们对 2016 年在单一学术儿童 ED 或单一普通学术 ED 就诊的 12-21 岁女性患者进行了一项回顾性队列研究。我们检查了妇科疾病发生率的差异。机构之间的历史和相关考试，使用逆概率权重调整前后。

结果

共有 837 名女性符合本研究的纳入标准，627 名患者被纳入调整分析。儿科机构更常见的结果包括避孕记录（普通急诊科 28% 对儿科急诊科 43% ，P < .001）、性传播感染检测（普通急诊科 32% 对儿科 42% ED，P  = .04）和放射成像（普通 ED 为 46%，儿科 ED 为 70%，P < .001）。在普通 ED 中更常见的结果是盆腔检查（普通 ED 为 26%，儿科 ED 为 10%，P < .001）和全血细胞计数（普通 ED 为 67%，儿童 ED 为 39%）儿科 ED, P< .001)。在月经初潮或性活动的记录、妊娠试验或 CT 扫描的表现，或随后一年的 ED/紧急护理访问率方面，各机构之间没有观察到差异。

结论

在普通 ED 和儿科 ED 中出现腹痛的青春期女性进行妇科病史和盆腔检查的比率较低且不一致。提供者对性传播感染和怀孕检测的门槛应该较低。在有临床适当病史的情况下，应进行盆腔检查和诊断实验室检查。这些努力将确保对青春期妇女进行充分评估并减少不必要的卫生资源利用。