Pregnancy testing in women of reproductive age in US emergency departments, 2002 to 2006: assessment of a national quality measure.
OBJECTIVE
We assess performance and explore definitions for a new emergency department (ED) quality measure: the proportion of women aged 14 to 50 years who have abdominal pain and receive pregnancy testing (aimed at detecting ectopic pregnancy).


METHODS
We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (2002 to 2006) to test trends and predictors of the new measure, using both restrictive and broad definitions from the International Classification of Diseases, Ninth Revision (ICD-9) and reason-for-visit codes, and determine the proportion of women with ectopic pregnancy who had undergone pregnancy testing. For comparison, we conducted a detailed chart review in 4 US hospitals among patients who visited the ED in 2006.


RESULTS
Using a broad ICD-9 definition for inclusion in NHAMCS, 2.13 million women aged 14 to 50 years with abdominal pain visited an ED annually between 2002 and 2006. Of those, 33.0% (95% confidence interval [CI] 30.5% to 35.5%) received pregnancy testing. Testing rates were materially stable, regardless of the definition used (broad or restrictive ICD-9 or reason-for-visit code). Among women with an ICD-9 diagnosis of ectopic pregnancy, 55.6% (95% CI 43.7% to 67.6%) had a documented pregnancy test. In the chart review, among 200 women aged 14 to 50 years and with abdominal pain, 89.4% (95% CI 85.0% to 94.0%) were eligible for the measure; of those, 93.9% (95% CI 90.3% to 97.4%) received testing.


CONCLUSIONS
Analysis of national ED survey data demonstrated a large performance gap for a new pregnancy testing quality measure, whereas focused chart review at 4 sites showed a smaller gap. Given these discrepancies, additional study is recommended before the widespread implementation of the pregnancy testing measure as an assessment of ED performance.
Schuur
Jeremiah D
JD
Department of Emergency Medicine, Brigham and Women's Hospital, and the Department of Medicine, Harvard Medical School, Boston, MA, USA. jschuur@partners.org
Tibbetts
Sarah A
SA
Pines
Jesse M
JM
D015746:Abdominal Pain / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D011258:Pregnancy Tests / Q000706:statistics & numerical data*; D011271:Pregnancy, Ectopic / Q000175:diagnosis; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult