Source:
Investigators from Nationwide Children’s Hospital, Columbus, OH, and Baylor College of Medicine, Houston, TX, conducted a retrospective study to describe laboratory testing and radiographic evaluation in adolescent females presenting to the ED with abnormal uterine bleeding (AUB) and compare differences in evaluations between white and Black patients. For the study, they reviewed data from the Pediatric Health Information System (PHIS) database, which includes demographic, diagnostic, and resource utilization data on encounters at 47 children’s hospitals in the US. Participants were females 8-21 years old with AUB, identified using ICD-10 codes, who had been seen at a participating ED between 2015 and 2020. The data abstracted on study participants included age, race and ethnicity, laboratory tests ordered for evaluation of anemia (complete count blood count or hemoglobin), iron deficiency (ferritin, iron, total iron binding capacity, or transferrin), bleeding disorder (prothrombin/partial thromboplastin time, clotting factors, von Willebrand antigen or activity, fibrinogen, or platelet aggregation), sexually transmitted infections (STI), hypothyroidism, and pregnancy. Orders for pelvic ultrasounds also were noted.
To assess whether AUB occurred disproportionately in minority adolescents, the rates of Black and Hispanic/Latino females presenting to the ED with AUB were compared to the rates of all females, 13-21 years old, seen in the participating EDs during the study period using chi-square tests. Chi-square tests also were used to compare rates of evaluation for anemia, iron deficiency, hypothyroidism and pregnancy, and pelvic ultrasounds in white and Black patients. Regression analyses were used to compare rates of STI and bleeding disorder evaluations in white and Black patients, after adjusting for confounding variables.
Data were analyzed on 17,759 females with AUB, with a median age of 16.3 years (interquartile range 14.1-17.8 years). Among these patients, 39.1% were white and 34.7% Black; 28.9% were of Hispanic/Latino ethnicity. Compared to all females 13-21 years old seen in the ED, Black and Hispanic/Latino females were overrepresented among those with AUB (P <0.0001 for both comparisons). White patients with AUB were more likely than Black adolescents to have evaluations for anemia (69.3% vs 58.6%; P <0.001), iron deficiency (8.0% vs 6.0%; P <0.001), and hypothyroidism (13.7% vs 9.7%; P <0.001), and also were more likely to have a pelvic ultrasound ordered (21.7% vs 14.0%; P <0.001). Conversely, Black females with AUB were significantly more likely to have an evaluation for pregnancy than white patients (74.6% vs 65.7%; P <0.001). In multivariate analyses, Black adolescents with AUB were significantly less likely to have an evaluation for a bleeding disorder (OR, 0.76; 95% CI, 0.69, 0.83) and significantly more likely to have an evaluation for STI (OR, 1.76; 95% CI, 1.48, 1.80) than white females.
The authors conclude that there are racial differences in the types of evaluations obtained in females presenting to the ED...
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