title: Disease surveillance in the ED: factors leading to the underreporting of gonorrhea.
abstract: Emergency departments (EDs) are potentially important surveillance sites. This study assessed reporting completeness for gonorrhea by hospital and gender and explored reasons for underreporting. A retrospective review was conducted of ED charts from three hospitals for 2 months. Potential gonorrhea cases were identified by history, physical examination, testing, treatment, and diagnostic practices. Cases were divided into those tested only, those treated with or without testing, and those with positive tests. Reporting completeness was assessed for each. Of 936 cases included, 29.0% were tested without treatment and 71% received treatment. One third of treated patients were not tested, and none of these were reported. Two EDs reported cases themselves and reported 75.9% of confirmed cases. There were significant differences in testing and reporting between hospitals and genders. Underreporting of suspected and confirmed gonorrhea cases was common from these EDs. A major cause was physicians treating without testing for confirmation.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Kirsch
authors.forename: R
authors.initials: R
authors.lastname: Shesser
authors.forename: M
authors.initials: M
authors.lastname: Barron
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D018563:Disease Notification / Q000706:statistics & numerical data; D004219:District of Columbia / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008487:Medical History Taking; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology; D010808:Physical Examination; D011159:Population Surveillance; D012189:Retrospective Studies; D012737:Sex Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014526:Urethritis / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents