Amy E Lawrence1, Emma Ervin2, Yuri V Sebastião2, Geri Hewitt3, Peter C Minneci1, Katherine J Deans4. 1. Center for Surgical Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. 2. Center for Surgical Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH. 3. Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, OH; Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus, OH. 4. Center for Surgical Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. Electronic address: Katherine.Deans@nationwidechildrens.org.
Abstract
STUDY OBJECTIVE: Evaluation of acute abdominal pain in an adolescent female patient should include consideration of all potential sources of pain, including gynecologic etiologies. The goal of our study was to determine the frequency of evaluation of gynecologic causes of abdominal pain in adolescent girls seen in a pediatric emergency department. STUDY DESIGN: A retrospective review was performed of girls between 12 and 21 years of age presenting to the emergency department or urgent care centers at a single pediatric institution with the chief complaint of abdominal pain during 2016. Frequency analyses of demographic and clinical characteristics are presented. RESULTS: One thousand and eighty-two girls presented with a chief complaint of abdominal pain. Menarche was documented in 85% of patients, sexual history in 52% of patients, and assessment of contraception use in 28%. Pregnancy testing was performed in 77%. STI testing was performed in 31%, and in only 73% of patients who reported being sexually active. Imaging was performed in 52%. In the subgroup of patients who reported being sexually active and presented with abdominal pain and vaginal discharge, only 37% had a pelvic exam performed. In multivariable modeling, Black patients were significantly more likely than white patients to have STI testing performed (aRR 1.39; CI: 1.13-1.70) and undergo a pelvic exam (aRR 2.45; CI: 1.34-4.50), and less likely to undergo imaging (aRR 0.69; CI: 0.59-0.81). CONCLUSION: The assessment of abdominal pain in adolescent girls should include gynecologic etiologies. Our results raise concerns that there are deficiencies in the evaluation of gynecologic sources of abdominal pain in girls treated at pediatric facilities and evidence of potential racial disparities.
STUDY OBJECTIVE: Evaluation of acute abdominal pain in an adolescent female patient should include consideration of all potential sources of pain, including gynecologic etiologies. The goal of our study was to determine the frequency of evaluation of gynecologic causes of abdominal pain in adolescent girls seen in a pediatric emergency department. STUDY DESIGN: A retrospective review was performed of girls between 12 and 21 years of age presenting to the emergency department or urgent care centers at a single pediatric institution with the chief complaint of abdominal pain during 2016. Frequency analyses of demographic and clinical characteristics are presented. RESULTS: One thousand and eighty-two girls presented with a chief complaint of abdominal pain. Menarche was documented in 85% of patients, sexual history in 52% of patients, and assessment of contraception use in 28%. Pregnancy testing was performed in 77%. STI testing was performed in 31%, and in only 73% of patients who reported being sexually active. Imaging was performed in 52%. In the subgroup of patients who reported being sexually active and presented with abdominal pain and vaginal discharge, only 37% had a pelvic exam performed. In multivariable modeling, Black patients were significantly more likely than white patients to have STI testing performed (aRR 1.39; CI: 1.13-1.70) and undergo a pelvic exam (aRR 2.45; CI: 1.34-4.50), and less likely to undergo imaging (aRR 0.69; CI: 0.59-0.81). CONCLUSION: The assessment of abdominal pain in adolescent girls should include gynecologic etiologies. Our results raise concerns that there are deficiencies in the evaluation of gynecologic sources of abdominal pain in girls treated at pediatric facilities and evidence of potential racial disparities.