title: A Computerized Sexual Health Survey Improves Testing for Sexually Transmitted Infection in a Pediatric Emergency Department.
abstract: To assess whether clinical decision support, using computerized sexually transmitted infection (STI) risk assessments, results in increased STI testing of adolescents at high risk for STI.
  
  
  
  In a 2-arm, randomized, controlled trial conducted at a single, urban, pediatric emergency department, adolescents completed a computerized sexual health survey. For patients assigned to the intervention arm, attending physicians received decision support to guide STI testing based on the sexual health survey-derived STI risk; in the usual care arm, decision support was not provided. We compared STI testing rates between the intervention and usual care groups, adjusting for potential confounding using multivariable logistic regression.
  
  
  
  Of the 728 enrolled patients, 635 (87.2%) had evaluable data (323 intervention arm; 312 usual care arm). STI testing frequency was higher in the intervention group compared with the usual care group (52.3% vs 42%; aOR 2 [95% CI 1.1, 3.8]). This effect was even more pronounced among the patients who presented asymptomatic for STI (28.6 vs 8.2%; aOR 4.7 [95% CI 1.4-15.5]).
  
  
  
  Providing sexual health survey-derived decision support to emergency department clinicians led to increased testing rates for STI in adolescents at high risk for infection, particularly in those presenting asymptomatic for infection. Studies to understand potential barriers to decision support adherence should be undertaken to inform larger, multicenter studies that could determine the generalizability of these findings and whether this process leads to increased STI detection.
  
  
  
  ClinicalTrials.gov: NCT02509572.
authors.affiliation: Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC. Electronic address: mgoyal@childrensnational.org.
authors.forename: Monika K
authors.initials: MK
authors.lastname: Goyal
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Fein
authors.affiliation: Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC.
authors.forename: Gia M
authors.initials: GM
authors.lastname: Badolato
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Trent
authors.affiliation: Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.affiliation: Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC.
authors.forename: James M
authors.initials: JM
authors.lastname: Chamberlain
mesh_terms: D000293:Adolescent; D003658:Decision Making, Computer-Assisted; D004636:Emergency Service, Hospital; D005260:Female; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D010372:Pediatrics; D058996:Quality Improvement; D012737:Sex Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D016037:Single-Blind Method; D014505:Urban Population
keywords: adolescent