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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Article info
Publication history
Published online: April 14, 2022
Accepted:
April 4,
2022
Received in revised form:
February 16,
2022
Received:
December 9,
2021
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
