ABSTRACT
Study Objective
To assess initial evaluation patterns of patients presenting to the Emergency Department
(ED) with abnormal uterine bleeding (AUB) including differences by race
Design
Retrospective multicenter cohort study from October 2015 through September 2020
Setting
Forty-seven children's hospitals submitting data to the Pediatric Health Information
System
Participants
Female patients aged 8-21 with an ED encounter with AUB as the primary diagnosis code
Interventions and Main Outcome Measures
Proportion of visits with at least 1 laboratory assessment for the evaluation of anemia,
iron deficiency, and/or hemostatic disorders
Results
We identified 17,759 unique patients with AUB seen in the ED who met inclusion criteria.
Median age was 16.3 years (IQR, 14.1-17.8 years). Most encounters (n = 11,576, 65.2%) included evaluation for anemia, but only 6.8% (n = 1,215) included assessment for iron deficiency and 26.2% (n = 4,654) for hemostatic disorders. Black patients accounted for 34.7% (n = 6,155) of AUB encounters yet constituted only 25% of all ED encounters (n = 198,192). Black patients with AUB were less likely to undergo bleeding disorder
evaluation (OR = 0.76; 95% CI, 0.69-0.83) but more likely to receive evaluation for
sexually transmitted infections (OR = 1.63; 95% CI, 1.48-1.80) compared with White
patients, despite controlling for age and concomitant pain.
Conclusions
In a national cohort of adolescents presenting to the ED with AUB, evaluations for
anemia and hemostatic disorders were infrequently performed, and racial differences
existed regarding initial assessment. Further studies are needed to understand the
factors underlying racial differences in hematologic testing and the impact of this
disparity on health outcomes for females with AUB.
Key Words
Abbreviations:
ED (emergency department), AUB (abnormal uterine bleeding), STI (sexually transmitted infection), CBC (complete blood count), PHIS (pediatric health information system), US (United States), IQR (interquartile range), OR (odds ratio), CI (confidence interval), PT (prothrombin time), PTT (partial thromboplastin time)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 06, 2022
Accepted:
December 29,
2021
Received in revised form:
December 15,
2021
Received:
September 8,
2021
Footnotes
The authors have no conflicts of interest to disclose.
The authors received no specific funding for this work.
This work was presented virtually due to the COVID-19 pandemic at the 2021 International Society on Thrombosis and Haemostasis Congress on July 17-21, 2021.
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
