青少年急诊患者常被漏查妊娠试验

新奥尔良——乔治•华盛顿大学的Monika Goyal博士报告称，对全国数据的分析结果显示，女性青少年急诊患者很少做妊娠筛查，哪怕她们有下腹痛症状或接受了放射性检查。

Monika K. Goyal博士

这项回顾性分析纳入了2000~2009年全美22,866家医疗机构的年龄14~21岁女性急诊患者的资料。在总共7,700万例次女性青少年急诊中，仅有约19%(1,450例次)进行了妊娠试验。

在那些有下腹痛症状的患者中，也仅有42%接受了妊娠试验。同时，在接受了放射性检查的患者中，仅有22%也接受了妊娠试验。在暴露于潜在致畸性辐射(例如胸部X线检查或CT扫描)的患者中，妊娠筛查率仅为28%。

Goyal博士指出，若干因素与这种疏忽有关。“我们往往将妊娠视为成年人的事情，而在评估青少年患者时常常不会考虑到这一问题。”

评论专家、美国儿科学会青少年委员会的Cora Collette Breuner博士认为这是一项很棒的研究，其结果令人惊异。“我没想到腹痛患者的妊娠筛查率也这么低。”但他也指出：“在急诊室内可能难以保持私密性，我们担心(提及妊娠相关问题)会触怒患者及其家人。”

Goyal博士认为，将性行为史列为青少年患者病史采集的标准项目，以及在患者可能暴露于致畸性检查时进行妊娠筛查，都是提高筛查率的途径之一。她建议儿科医生对每一名青少年患者都要采集到明确的性行为史。

Goyal博士和Breuner博士均无利益冲突披露。

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By: NASEEM S. MILLER, Ob.Gyn. News Digital Network

NEW ORLEANS – Few adolescent girls who visited an emergency department were screened for pregnancy, even if they presented with lower abdominal pain or underwent a radiologic exam, according to analysis of national data.

Several factors could contribute to the lapse, according to lead author Dr. Monika Goyal.
 
"We, as providers, consider pregnancy to be more an adult issue and often fail to consider it when evaluating teenagers," said Dr. Goyal of the departments of pediatrics and emergency medicine at George Washington University, Washington.

Dr. Cora Collette Breuner, discussant and a member of the AAP Committee on Adolescence, noted that it can be difficult to see an adolescent confidentially in the ED setting. "We’re afraid of offending the patients and their families," she said.

Indeed, interventions that standardize sexual history taking for every adolescent, and pregnancy screening when patients may be exposed to teratogenic tests is among the solutions to increase the screening rates, said Dr. Goyal, who is also an attending ED physician at Children’s National Medical Center in Washington.

In her retrospective analysis, Dr. Goyal and her colleagues used the National Hospital Ambulatory Medical Care Survey from 2000 to 2009, identifying 22,866 records of female patients aged 14-21 years who were evaluated in EDs.

Of the 77 million female adolescents who visited ED during the 9-year-period, about 19% (14.5 million) received a pregnancy test.

Of those who presented with lower abdominal pain, 42% were tested. Meanwhile, 22% of those who underwent radiologic imaging were tested for pregnancy, so did 28% of the patients were exposed to potentially teratogenic radiation, such as chest radiographs or CT scans. Black patients, as well as those with non-private health insurance, who were admitted, and those with a chief complaint of lower abdominal pain or genitourinary symptoms were significantly more likely to be screened for pregnancy.

"This is a well-done study, and the findings are a bit surprising," commented Dr. Breuner, who is also a professor of adolescent medicine at the University of Washington, Seattle. "I really thought the numbers [for pregnancy screening] would be higher for abdominal pain."

Dr. Goyal advised pediatricians to conduct a confidential sexual history with every adolescent patient.

"Furthermore, we should have standardized protocols for pregnancy testing for complaints that may be associated with pregnancy related symptoms or anytime a patient may be exposed to therapies or diagnostics that may be harmful if pregnant."

Dr. Goyal and Dr. Breuner had no disclosures.