To estimate frequency of pregnancy testing among adolescent emergency department (ED) patients and determine factors associated with pregnancy testing.
We performed a retrospective cross-sectional study using the National Hospital Ambulatory Medical Care Survey from 2000-2009 of female patients between ages 14 to 21 evaluated in the ED. Frequency of pregnancy testing was calculated and national estimates were obtained using validated patient visit weights. Multivariable logistic regression was performed to evaluate factors associated with pregnancy testing.
During 2000-2009, 22,866 records were identified representing 77 million female adolescent ED visits. Of these, only 14.5 million (18.7%) underwent pregnancy testing. Of patients presenting with lower abdominal pain, just 42.3% underwent pregnancy testing. Among patients who had radiologic imaging performed, only 21.5% underwent pregnancy testing. Furthermore, among patients who had exposure to potentially teratogenic radiation (e.g. chest radiograph or cat scan), only 27.9% had pregnancy testing conducted. In a multivariable model, age ≥17 years (OR 1.45, 95% CI 1.29, 1.61), Black race (OR 1.29, 95% CI 1.15, 1.43), non-private insurance (OR 1.12, 95% CI 1.02, 1.24), hospitalization (OR 1.33, 95% CI 1.08, 1.62) and chief complaint of lower abdominal pain or genitourinary symptoms (OR 5.5, 95% CI 5.1, 5.9) remained significantly associated with pregnancy testing.
We found that a minority of adolescent females presenting to the ED underwent pregnancy testing, even when presenting with lower abdominal pain or receiving potentially teratogenic radiologic examinations. Disparities in pregnancy testing were noted based on age, race, and insurance testing. Future studies should focus on designing interventions to increase pregnancy testing in adolescent ED patients, especially among those presenting with lower abdominal pain or undergoing radiologic imaging.