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Comparing the Evaluation of Abdominal Pain in Adolescent Females at a Pediatric vs General Emergency Department

  • Amanda J. Onwuka
    Affiliations
    Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
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  • Maria E. Knaus
    Affiliations
    Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States

    Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
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  • Amy E. Lawrence
    Affiliations
    Department of Surgery, Division of General Surgery, The University of Rochester, Rochester, New York
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  • Yuri V. Sebastião
    Affiliations
    Division of Global Women's Health, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina
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  • Jordee M. Wells
    Affiliations
    Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH

    Department of Pediatrics, Division of Emergency Medicine, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
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  • Michael J. Stoner
    Affiliations
    Department of Pediatrics, Division of Emergency Medicine, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
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  • Geri Hewitt
    Affiliations
    Department of Surgery, Division of Pediatric and Adolescent Gynecology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
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  • Katherine J. Deans
    Affiliations
    Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States

    Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
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  • Peter C. Minneci
    Correspondence
    Corresponding author at: Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
    Affiliations
    Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States

    Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Published:April 14, 2022DOI:https://doi.org/10.1016/j.jpag.2022.04.002

      Abstract

      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.

      Keywords

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