<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>

<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>

<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>