Emergency Contraception Candidacy in the Pediatric Emergency Department

Purpose: The majority of adolescent pregnancies are unintended. Adolescents who access the emergency department (ED) for care may be at high risk for unplanned pregnancy. The purpose of this study was to identify the proportion of adolescent females presenting to an urban ED who may be candidates for emergency contraception (EC). Methods: This was a secondary analysis of a randomized control trial conducted in an urban pediatric ED designed to determine whether provision of clinical decision support derived from a computerized sexual health screening tool resulted in increased testing for sexually transmitted infections among adolescents (ages 14-19 years) at high risk for infection. We calculated the prevalence of adolescent females who met candidacy for emergency contraception and the proportion of EC qualifying females who were interested in speaking to a clinician about EC. Results: 444 adolescent females were enrolled in this trial. The study population had a mean age of 16.25 years (SD +/- 1.65); 75.3% were non-Hispanic Black; and 25.5% were covered by private insurance. Overall, 210 (47.3%) of females were sexually active. 70 (33.3%) of those females reported vaginal intercourse within the last five days and were eligible for EC. Only 11 (15.7%) of eligible females, expressed interest in speaking with a clinician about EC (7 in intervention arm and 4 in usual care arm). Clinicians prescribed EC to 2 of 11 (18.2%) patients who expressed interest in EC receipt. Conclusions: Although a large proportion of adolescents were eligible for EC, few expressed interest in speaking with a clinician about EC. However, a large proportion of adolescents who were interested in EC receipt did not receive EC. Further studies should investigate adolescent attitudes towards ED-prescribed EC and barriers to EC provision by clinical staff

Racial and Ethnic Disparities in Receipt of Sexual Health Care and Education Among A Nationally Representative Sample of Adolescent Females

OBJECTIVE(S): The USA has a high rate of adolescent pregnancy, with non-Hispanic (NH) Black and Hispanic women disproportionately affected. We sought to investigate the presence of racial/ethnic disparities in the receipt of sexual health (SRH) care and education and whether such disparities contribute to differences in sexual health outcomes for youth. STUDY DESIGN: We conducted a cross-sectional study of females aged 15-21 years who participated in the National Survey of Family Growth from 2008 to 2015. Multivariable logistic regression was used to measure the association between race/ethnicity and SRH outcomes after adjustment for potential confounders. Models were developed to measure whether receipt of SRH care and education served as an effect modifier on SRH outcomes. RESULTS: The sample included 4316 participants, representing 33.5 million females. Almost half (47.2%) received birth control services in the last 12 months; NH-Blacks (aOR 0.7 [0.5, 0.9]) and Hispanics (aOR 0.6 [0.5, 0.8]) were less likely to have obtained birth control services than NH-whites. Hispanics (aOR 1.5 [1.2, 1.9]) had a higher likelihood of receipt of condom education than NH-whites. We found that disparities in SRH outcomes were slightly mitigated after adjustment for access to SRH care and education. CONCLUSIONS: We identified racial/ethnic disparities in sexual health outcomes and in SRH and education; however, SRH care and education can mitigate some of these differences in sexual behaviors and outcomes. Racial/ethnic differences in sexual health outcomes may be at least partially related to the differential receipt of sexual health care and education and deserve further investigation

Variability in advanced imaging of pediatric neck infections in US emergency departments

Objectives: To describe the use of computed tomography (CT) and ultrasound (US) imaging for the evaluation of neck infections in pediatric patients in United States emergency departments (EDs). Methods: This is a cross-sectional analysis, using the National Emergency Department Sample database, of pediatric patients evaluated for common neck infections between 2012 and 2018. We used bivariable analysis to assess for differences in US and CT use by ED type. We performed multivariable logistic regression to adjust for potential confounding factors including patient characteristics (sex, age, insurance status, discharge diagnosis) and ED characteristics (metropolitan statistical area, pediatric center). Results are reported as odds ratios and adjusted odds ratios with 95% confidence intervals. Results: There were 19,363 ED visits for pediatric neck infections in the database over the study period, representing 84,439 national visits. Of those imaged, 80.8% were imaged with CT and 19.2% were imaged with US. Pediatric patients evaluated in general EDs as compared to pediatric EDs (aOR 5.32, 95% CI 3.06, 9.24) and patients with a diagnosis of peritonsillar abscess (aOR 2.11, 95% CI 1.34, 3.33) and retropharyngeal abscess (aOR 6.12, 95% CI 2.14, 17.53) were more likely to be imaged with CT scan. Conclusions: Children with neck infections evaluated in general EDs are significantly more likely to undergo CT scans when compared to those evaluated in pediatric EDs. To reduce exposure to radiation in children, we propose the dissemination of US-first protocols in general EDs for the evaluation of pediatric neck infections

Determining Intentionality of Pediatric Firearm Injuries by International Classification of Disease Code

OBJECTIVE: Firearm injuries are a leading cause of serious injury and death in childhood. The accuracy of International Classification of Disease (ICD) codes to assign intent is unclear. The objective of this study was to assess the validity of documented ICD codes for firearm injury intent compared with chart review. METHODS: We performed a retrospective cohort study of children (\u3c= 18 years) presenting to a tertiary care level 1 pediatric trauma center with firearm injuries between 2006 and 2017. We compared agreement between ICD codes and intent of injury determined by medical record review using Cohen κ. Intent for medical record review was assigned via the injury spectrum of intentionality (suicide attempt, accidental firing, mistaken target, firearm assault and unknown). For comparison with ICD codes, all medical record review cases marked as mistaken target were classified as accidental. A sensitivity analysis was then performed, coding all mistaken targets as assault. RESULTS: There were 122 cases identified over the study period. The most common intent by ICD code was assault (n = 80, 65.6%). Medical record review categorized most injuries as mistaken targets. When mistaken target was categorized as accidental, most firearm injuries were coded as accidental (n = 89, 72.9%) Similar results were seen when mistaken target was categorized as assault, most injuries were categorized as assault (n = 79, 79.5%) Cohen κ was 0.15 when mistaken targets were categorized as accident and 0.30 when categorized as assault. CONCLUSIONS: The ICD codes do not fully describe the intent of firearm injury. Revising ICD codes to account for mistaken targets could help to improve the validity of ICD codes for intent

Adolescent Attitudes Toward Sexually Transmitted Infection Screening in the Emergency Department.

OBJECTIVES: Adolescents who seek care in emergency departments (EDs) are often at high risk for sexually transmitted infections (STIs). The objective of this study was to assess adolescent attitudes towards ED-based STI screening. METHODS: We conducted a secondary analysis of a cross-sectional study that evaluated STI screening acceptability and prevalence when STI testing was universally offered to asymptomatic adolescents presenting to the ED for care. Adolescents 14–21 years old completed a computerized survey and answered questions regarding attitudes towards ED-based STI screening and sexual behavior. We performed multivariable logistic regression to compare differences in attitudes towards ED-based STI screening among patients who agreed versus declined STI testing. RESULTS: 326 of 553 (59.0%) adolescents agreed to be tested for STIs. The majority (72.1%) believed the ED was an appropriate place for STI screening. Patients who agreed to be tested for STIs were more likely to positively endorse ED-based STI screening than those who declined STI testing (77.0% vs 64.8%%; aOR 1.6, [95% CI 1.1, 2.4]). Most (82.6%) patients stated they would feel comfortable getting tested for STI’s in the ED. There was no difference in comfort level of ED-based STI testing between those who agreed and declined STI testing (83.5% vs 81.4% aOR 1.1, [95% CI 0.7, 1.8]). CONCLUSION: Our results suggest that adolescents view the ED as an acceptable location for STI screening. Therefore the ED may serve a role in increasing the accessibility of STI detection and prevention resources for adolescents

Frequency of Prescription Filling Among Adolescents Prescribed Treatment for Sexually Transmitted Infections in the Emergency Department.

This study investigates prescription filling for the treatment of sexually transmitted infections among adolescents in the emergency department setting

Frequency of Prescription Filling Among Adolescents Prescribed Treatment for Sexually Transmitted Infections in the Emergency Department.

This study investigates prescription filling for the treatment of sexually transmitted infections among adolescents in the emergency department setting

Frequency of Opioid Prescription Filling After Discharge from the Pediatric Emergency Department

BACKGROUND: Little is known about prescription filling of pain medicine for children. In adult populations, race and insurance type are associated with differences in opioid prescription fill rate. We hypothesize that known disparities in pain management for children are exacerbated by the differential rates of opioid prescription filling between patients based on age and race. OBJECTIVE: To determine if there are demographic or clinical factors associated with differences in opioid prescription fill rates after discharge from the pediatric emergency department (ED). METHODS: This was a retrospective cross-sectional study of all patients younger than 19 years discharged with an opioid prescription from either of two pediatric EDs in 2018. We performed multivariable logistic regression to measure associations between prescription filling and demographic and clinical factors. RESULTS: There were 287 patient visits in which opioids were prescribed. Forty percent of prescriptions were filled. The majority of patients were male (53%), black (69%), and had public insurance (55%). There were no significant associations between prescription filling and age, insurance status, or race/ethnicity. Patients with sickle cell disease were more likely to fill prescriptions (odds ratio 3.87, 95% confidence interval 2.33-6.43) and patients without an identified primary care provider were less likely to fill prescriptions (odds ratio 0.16, 95% confidence interval 0.03-0.84). CONCLUSION: Less than half of opioid prescriptions prescribed at discharge from a pediatric emergency department are filled. Patient age, insurance status, and race/ethnicity are not associated with opioid prescription filling. Patients with sickle cell disease and those with a primary care provider are more likely to fill their opioid prescriptions