Emergency Department Evaluation of Abnormal Uterine Bleeding in US Children's Hospitals

被引:6
作者
Kendel, Nicole E. [1 ]
Stanek, Joseph R. [1 ,2 ]
Haamid, Fareeda W. [3 ]
Powers, Jacquelyn M. [4 ,5 ]
O'Brien, Sarah H. [1 ]
机构
[1] Nationwide Childrens Hosp, Div Pediat Hematol Oncol, Columbus, OH USA
[2] Nationwide Childrens Hosp, Biostat Resource, Columbus, OH USA
[3] Nationwide Childrens Hosp, Div Adolescent Med, Columbus, OH USA
[4] Baylor Coll Med, Sect Hematol Oncol, Dept Pediat, Houston, TX USA
[5] Texas Childrens Hosp, Houston, TX USA
关键词
Abnormal uterine bleeding; Hemostatic evaluation; Hormonal therapy; Bleeding disorder; Emergency department; IRON-DEFICIENCY; ADOLESCENTS; MENSTRUATION; ANEMIA; VISITS; TRENDS; GIRLS;
D O I
10.1016/j.jpag.2021.12.016
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Study Objective: To assess initial evaluation patterns of patients presenting to the Emergency Department (ED) with abnormal uterine bleeding (AUB) including differences by race Design: Retrospective multicenter cohort study from October 2015 through September 2020 Setting: Forty-seven children's hospitals submitting data to the Pediatric Health Information System Participants: Female patients aged 8-21 with an ED encounter with AUB as the primary diagnosis code Interventions and Main Outcome Measures: Proportion of visits with at least 1 laboratory assessment for the evaluation of anemia, iron deficiency, and/or hemostatic disorders Results: We identified 17,759 unique patients with AUB seen in the ED who met inclusion criteria. Median age was 16.3 years (IQR, 14.117.8 years). Most encounters (n = 11,576, 65.2%) included evaluation for anemia, but only 6.8% (n = 1,215) included assessment for iron deficiency and 26.2% (n = 4,654) for hemostatic disorders. Black patients accounted for 34.7% (n = 6,155) of AUB encounters yet constituted only 25% of all ED encounters (n = 198,192). Black patients with AUB were less likely to undergo bleeding disorder evaluation (OR = 0.76; 95% CI, 0.69-0.83) but more likely to receive evaluation for sexually transmitted infections (OR = 1.63; 95% CI, 1.48-1.80) compared with White patients, despite controlling for age and concomitant pain. Conclusions: In a national cohort of adolescents presenting to the ED with AUB, evaluations for anemia and hemostatic disorders were infrequently performed, and racial differences existed regarding initial assessment. Further studies are needed to understand the factors underlying racial differences in hematologic testing and the impact of this disparity on health outcomes for females with AUB.
引用
收藏
页码:288 / 293
页数:6
相关论文
共 20 条
[1]   Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents [J].
Borzutzky, Claudia ;
Jaffray, Julie .
JAMA PEDIATRICS, 2020, 174 (02) :186-194
[2]   Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease [J].
Brown, Megan C. ;
White, Michael H. ;
Friedberg, Rachel ;
Woods, Kalinda ;
Childress, Krista ;
Kulkarni, Mona ;
Sidonio, Robert F. .
RESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS, 2021, 5 (04)
[3]  
Centers for Disease Control and Prevention, 2018, WILL DIS
[4]  
Centers for Disease Control and Prevention, 2024, Health disparities in Black or African American people. Health disparities in HIV, viral hepatitis, STDs, & tuberculosis
[5]   Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding [J].
Cooke, Amanda G. ;
McCavit, Timothy L. ;
Buchanan, George R. ;
Powers, Jacquelyn M. .
JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY, 2017, 30 (02) :247-250
[6]   Hemostatic Abnormalities in Young Females with Heavy Menstrual Bleeding [J].
Diaz, Rosa ;
Dietrich, Jennifer E. ;
Mahoney, Donald, Jr. ;
Yee, Donald L. ;
Srivaths, Lakshmi V. .
JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY, 2014, 27 (06) :324-329
[7]   Abnormal vaginal bleeding in adolescents [J].
Gray, Susan Hayden ;
Emans, S. Jean .
PEDIATRICS IN REVIEW, 2007, 28 (05) :175-181
[8]   Heavy Menstrual Bleeding in Adolescents [J].
Haamid, Fareeda ;
Sass, Amy E. ;
Dietrich, Jennifer E. .
JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY, 2017, 30 (03) :335-340
[9]   Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review [J].
Hall, William J. ;
Chapman, Mimi V. ;
Lee, Kent M. ;
Merino, Yesenia M. ;
Thomas, Tainayah W. ;
Payne, B. Keith ;
Eng, Eugenia ;
Day, Steven H. ;
Coyne-Beasley, Tamera .
AMERICAN JOURNAL OF PUBLIC HEALTH, 2015, 105 (12) :E60-E76
[10]   Iron Deficiency without Anemia: A Common Yet Under-Recognized Diagnosis in Young Women with Heavy Menstrual Bleeding [J].
Johnson, Stephen ;
Lang, Abigail ;
Sturm, Mollie ;
O'Brien, Sarah H. .
JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY, 2016, 29 (06) :628-631