First name
Monika
Last name
Goyal

Title

Frequency of pregnancy testing among adolescent emergency department visits.

Year of Publication

2013

Number of Pages

816-21

Date Published

2013 Aug

ISSN Number

1553-2712

Abstract

<p><strong>OBJECTIVES: </strong>The objective was to estimate the frequency of pregnancy testing among adolescent emergency department (ED) patients and to determine factors associated with testing.</p>

<p><strong>METHODS: </strong>This was a retrospective cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 through 2009 of ED visits by females ages 14 to 21 years. The frequency of pregnancy testing among all visits was estimated for potential reproductive health complaints and for those associated with exposure to potentially teratogenic radiation. Multivariable logistic regression modeling was performed to calculate adjusted probabilities and odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate factors associated with pregnancy testing by patient characteristics.</p>

<p><strong>RESULTS: </strong>The authors identified 11,531 visits, representing an estimated 41.0 million female adolescent ED visits. Of these, 20.9% (95% CI = 19.3% to 22.5%) included pregnancy testing. Among visits for potential reproductive health complaints and those associated with exposure to potentially teratogenic radiation, 44.5% (95% CI = 41.3% to 47.8%) and 36.7% (95% CI = 32.5% to 40.9%), respectively, included pregnancy testing. Among the entire study population, we found statistically significant differences in pregnancy testing by age, race or ethnicity, hospital admission, and geographic region (p &lt; 0.001 for all).</p>

<p><strong>CONCLUSIONS: </strong>A minority of female adolescent ED visits included pregnancy testing, even if patients presented with potential reproductive health complaints or received exposure to ionizing radiation. Small but statistically significant differences in pregnancy testing rates were noted based on age, race or ethnicity, ED disposition, and geographic region. Future studies should focus on designing quality improvement interventions to increase pregnancy testing in adolescent ED patients, especially among those in whom pregnancy complications or the risk of potentially teratogenic radiation exposure is higher.</p>

DOI

10.1111/acem.12186

Alternate Title

Acad Emerg Med

PMID

24033625

Title

National trends in pelvic inflammatory disease among adolescents in the emergency department.

Year of Publication

2013

Number of Pages

249-52

Date Published

2013 Aug

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>In 2002, the Centers for Disease Control and Prevention (CDC) broadened the pelvic inflammatory disease (PID) diagnostic criteria to increase detection and prevent serious sequelae of untreated PID. The impact of this change on PID detection is unknown. Our objectives were to estimate trends in PID diagnosis among adolescent emergency department (ED) patients before and after the revised CDC definition and to identify factors associated with PID diagnoses.</p>

<p><strong>METHODS: </strong>We performed a retrospective repeated cross-sectional study using the National Hospital Ambulatory Medical Care Survey from 2000 to 2009 of ED visits by 14- to 21-year-old females. We calculated national estimates of PID rates and performed multivariable logistic regression analyses and tests of trends.</p>

<p><strong>RESULTS: </strong>During 2000-2009, of the 77 million female adolescent ED visits, there were an estimated 704,882 (95% confidence interval [CI], 571,807-837,957) cases of PID. After the revised criteria, PID diagnosis declined from 5.4 cases per 1,000 United States adolescent females to 3.9 cases per 1,000 (p = .03). In a multivariable model, age ≥17 years (odds ratio, 2.14; 95% CI, 1.25-3.64) and black race (odds ratio, 2.04; 95% CI, 1.36-3.07) were associated with PID diagnosis.</p>

<p><strong>CONCLUSIONS: </strong>Despite broadened CDC diagnostic criteria, PID diagnoses did not increase over time. This raises concern about awareness and incorporation of the new guidelines into clinical practice.</p>

DOI

10.1016/j.jadohealth.2013.03.016

Alternate Title

J Adolesc Health

PMID

23743002

Title

Fluoroquinolone resistance in pediatric bloodstream infections because of Escherichia coli and Klebsiella species.

Year of Publication

2008

Number of Pages

70-3

Date Published

2008 Feb

ISSN Number

1527-3296

Abstract

<p>In pediatric bloodstream infections with fluoroquinolone (FQ)-resistant Escherichia coli and Klebsielia species, we noted an association between FQ resistance and extended-spectrum beta-lactamase (ESBL) production (OR, 12; 95% CI: 2.28-83.8). A case control study revealed no significant risk factors (including prior antibiotic use) for FQ resistance among ESBL E coli and Klebsiella species (ESBL-EK).</p>

DOI

10.1016/j.ajic.2007.01.012

Alternate Title

Am J Infect Control

PMID

18241740

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