title: Frequency of pregnancy testing among adolescent emergency department visits.
abstract: OBJECTIVE
  The objective was to estimate the frequency of pregnancy testing among adolescent emergency department (ED) patients and to determine factors associated with testing.
  
  
  METHODS
  This was a retrospective cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 through 2009 of ED visits by females ages 14 to 21 years. The frequency of pregnancy testing among all visits was estimated for potential reproductive health complaints and for those associated with exposure to potentially teratogenic radiation. Multivariable logistic regression modeling was performed to calculate adjusted probabilities and odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate factors associated with pregnancy testing by patient characteristics.
  
  
  RESULTS
  The authors identified 11,531 visits, representing an estimated 41.0 million female adolescent ED visits. Of these, 20.9% (95% CI = 19.3% to 22.5%) included pregnancy testing. Among visits for potential reproductive health complaints and those associated with exposure to potentially teratogenic radiation, 44.5% (95% CI = 41.3% to 47.8%) and 36.7% (95% CI = 32.5% to 40.9%), respectively, included pregnancy testing. Among the entire study population, we found statistically significant differences in pregnancy testing by age, race or ethnicity, hospital admission, and geographic region (p < 0.001 for all).
  
  
  CONCLUSIONS
  A minority of female adolescent ED visits included pregnancy testing, even if patients presented with potential reproductive health complaints or received exposure to ionizing radiation. Small but statistically significant differences in pregnancy testing rates were noted based on age, race or ethnicity, ED disposition, and geographic region. Future studies should focus on designing quality improvement interventions to increase pregnancy testing in adolescent ED patients, especially among those in whom pregnancy complications or the risk of potentially teratogenic radiation exposure is higher.
authors.affiliation: Children's National Medical Center, Washington, DC; George Washington University, Washington, DC; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Monika
authors.initials: M
authors.lastname: Goyal
authors.forename: Adam
authors.initials: A
authors.lastname: Hersh
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.forename: Cynthia
authors.initials: C
authors.lastname: Mollen
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.forename: Maria
authors.initials: M
authors.lastname: Trent
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011258:Pregnancy Tests / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
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