<p><strong>OBJECTIVE: </strong>The objective was to develop a content-valid audio computer-assisted self-interview (ACASI) sexual health survey (SHS) that is understandable and acceptable to adolescents and can be feasibly implemented in a pediatric emergency department (ED) for sexually transmitted infection (STI) risk assessment.</p>

<p><strong>METHODS: </strong>Multistep iterative qualitative study utilizing a Delphi panel of key informants for survey development and content validity, cognitive interviews with end-users to evaluate understanding, and pilot testing with end-users to evaluate acceptability and feasibility.</p>

<p><strong>RESULTS: </strong>We developed a 20-item questionnaire through an iterative modified Delphi process with experts in adolescent and pediatric emergency medicine. All items were assessed as understandable by &gt;90% of adolescents during the cognitive interviews. All respondents found the SHS easy to use. A total of 76.5% preferred answering questions related to sexual health through the SHS compared to face-to-face interviews. Mean (±SD) length of survey completion was 17.5 (±6.7) minutes and 88.6% of participants found survey length to be "just right." With respect to feasibility testing, there was no statistically significant difference in median ED LOS between those who piloted the SHS and those who did not (230.0 minutes vs. 219.0 minutes; p = 0.7).</p>

<p><strong>CONCLUSIONS: </strong>We developed a content-valid ACASI for the identification of adolescents at risk for STIs that was understandable, acceptable, and easy to use by adolescent patients and feasible for implementation in the pediatric ED. Future planned steps include the evaluation of the SHS in providing clinical decision support for targeted STI screening in the ED.</p>

<p><strong>OBJECTIVES: </strong>To assess whether clinical decision support, using computerized sexually transmitted infection (STI) risk assessments, results in increased STI testing of adolescents at high risk for STI.</p>

<p><strong>STUDY DESIGN: </strong>In a 2-arm, randomized, controlled trial conducted at a single, urban, pediatric emergency department, adolescents completed a computerized sexual health survey. For patients assigned to the intervention arm, attending physicians received decision support to guide STI testing based on the sexual health survey-derived STI risk; in the usual care arm, decision support was not provided. We compared STI testing rates between the intervention and usual care groups, adjusting for potential confounding using multivariable logistic regression.</p>

<p><strong>RESULTS: </strong>Of the 728 enrolled patients, 635 (87.2%) had evaluable data (323 intervention arm; 312 usual care arm). STI testing frequency was higher in the intervention group compared with the usual care group (52.3% vs 42%; aOR 2 [95% CI 1.1, 3.8]). This effect was even more pronounced among the patients who presented asymptomatic for STI (28.6 vs 8.2%; aOR 4.7 [95% CI 1.4-15.5]).</p>

<p><strong>CONCLUSIONS: </strong>Providing sexual health survey-derived decision support to emergency department clinicians led to increased testing rates for STI in adolescents at high risk for infection, particularly in those presenting asymptomatic for infection. Studies to understand potential barriers to decision support adherence should be undertaken to inform larger, multicenter studies that could determine the generalizability of these findings and whether this process leads to increased STI detection.</p>

<p><strong>TRIAL REGISTRATION: </strong>ClinicalTrials.gov: NCT02509572.</p>

<p><strong>OBJECTIVES: </strong>The objectives were to estimate the frequency of pregnancy testing in emergency department (ED) visits by reproductive-aged women administered or prescribed teratogenic medications (Food and Drug Administration categories D or X) and to determine factors associated with nonreceipt of a pregnancy test.</p>

<p><strong>METHODS: </strong>This was a retrospective cross-sectional study using 2005 through 2009 National Hospital Ambulatory Medical Care Survey data of ED visits by females ages 14 to 40&nbsp;years. The number of visits was estimated where teratogenic medications were administered or prescribed and pregnancy testing was not conducted. The association of demographic and clinical factors with nonreceipt of pregnancy testing was assessed using multivariable logistic regression.</p>

<p><strong>RESULTS: </strong>Of 39,859 sampled visits, representing an estimated 141.0 million ED visits by reproductive-aged females nationwide, 10.1 million (95% confidence interval [CI]&nbsp;=&nbsp;8.9 to 11.3 million) estimated visits were associated with administration or prescription of teratogenic medications. Of these, 22.0% (95% CI&nbsp;=&nbsp;19.8% to 24.2%) underwent pregnancy testing. The most frequent teratogenic medications administered without pregnancy testing were benzodiazepines (52.2%; 95% CI&nbsp;=&nbsp;31.1% to 72.7%), antibiotics (10.7%; 95% CI&nbsp;=&nbsp;5.0% to 16.3%), and antiepileptics (7.7%; 95% CI&nbsp;=&nbsp;0.12% to 15.5%). The most common diagnoses associated with teratogenic drug prescription without pregnancy testing were psychiatric (16.1%; 95% CI&nbsp;=&nbsp;13.6% to 18.6%), musculoskeletal (12.7%; 95% CI&nbsp;=&nbsp;10.8% to 14.5%), and cardiac (9.5%; 95% CI&nbsp;=&nbsp;7.6% to 11.3%). In multivariable analyses, visits by older (adjusted odds ratio [AOR]&nbsp;= 0.57, 95% CI&nbsp;=&nbsp;0.42 to 0.79), non-Hispanic white females (AOR&nbsp;= 0.71; 95% CI&nbsp;=&nbsp;0.54 to 0.93); visits in the Northeast region (AOR&nbsp;= 0.60; 95% CI&nbsp;=&nbsp;0.42 to 0.86); and visits during which teratogenic medications were administered in the ED only (AOR&nbsp;= 0.74; 95% CI&nbsp;=&nbsp;0.57 to 0.97) compared to prescribed at discharge only were less likely to have pregnancy testing.</p>

<p><strong>CONCLUSIONS: </strong>A minority of ED visits by reproductive-aged women included pregnancy testing when patients were prescribed category D or X medications. Interventions are needed to ensure that pregnancy testing occurs before women are prescribed potentially teratogenic medications, as a preventable cause of infant morbidity.</p>