NEW ORLEANS – Few adolescent girls who visited an emergency department were screened for pregnancy, even if they presented with lower abdominal pain or underwent a radiologic exam, according to analysis of national data.
Several factors could contribute to the lapse, according to lead author Dr. Monika Goyal.
Dr. Monika K. Goyal
"We, as providers, consider pregnancy to be more an adult issue and often fail to consider it when evaluating teenagers," said Dr. Goyal of the departments of pediatrics and emergency medicine at George Washington University, Washington.
Dr. Cora Collette Breuner, discussant and a member of the AAP Committee on Adolescence, noted that it can be difficult to see an adolescent confidentially in the ED setting. "We’re afraid of offending the patients and their families," she said.
Indeed, interventions that standardize sexual history taking for every adolescent, and pregnancy screening when patients may be exposed to teratogenic tests is among the solutions to increase the screening rates, said Dr. Goyal, who is also an attending ED physician at Children’s National Medical Center in Washington.
In her retrospective analysis, Dr. Goyal and her colleagues used the National Hospital Ambulatory Medical Care Survey from 2000 to 2009, identifying 22,866 records of female patients aged 14-21 years who were evaluated in EDs.
Of the 77 million female adolescents who visited ED during the 9-year-period, about 19% (14.5 million) received a pregnancy test.
Of those who presented with lower abdominal pain, 42% were tested. Meanwhile, 22% of those who underwent radiologic imaging were tested for pregnancy, so did 28% of the patients were exposed to potentially teratogenic radiation, such as chest radiographs or CT scans. Black patients, as well as those with non-private health insurance, who were admitted, and those with a chief complaint of lower abdominal pain or genitourinary symptoms were significantly more likely to be screened for pregnancy.
"This is a well-done study, and the findings are a bit surprising," commented Dr. Breuner, who is also a professor of adolescent medicine at the University of Washington, Seattle. "I really thought the numbers [for pregnancy screening] would be higher for abdominal pain."
Dr. Goyal advised pediatricians to conduct a confidential sexual history with every adolescent patient.
"Furthermore, we should have standardized protocols for pregnancy testing for complaints that may be associated with pregnancy related symptoms or anytime a patient may be exposed to therapies or diagnostics that may be harmful if pregnant."
Dr. Goyal and Dr. Breuner had no disclosures.