Effectiveness of a Universally Offered Chlamydia and Gonorrhea Screening Intervention in the Pediatric Emergency Department |
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Authors: | Jennifer L. Reed Evaline A. Alessandrini Judith Dexheimer Andrea Kachelmeyer Maurizio Macaluso Nanhua Zhang Jessica A. Kahn |
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Affiliation: | 1. Division of Emergency Medicine, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;3. James M. Anderson Center for Health Systems Excellence, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;4. University of Cincinnati Health System, Cincinnati, Ohio;5. Department of Biomedical Informatics, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;6. Division of Biostatistics and Epidemiology, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;7. Division of Adolescent and Transition Medicine, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio |
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Abstract: | PurposeAdolescents represent more than half of the newly diagnosed sexually transmitted infections in the U.S. annually. Emergency departments (EDs) may serve as an effective, nontraditional setting to screen for chlamydia/gonorrhea (CT/GC). The objective was to evaluate the effectiveness of a universally offered CT/GC screening program in two pediatric ED settings.MethodsThis was a prospective, delayed start pragmatic study conducted over 18 months in two EDs within the same academic institution among ED adolescents aged 14–21 years with any chief complaint. Using a tablet device, adolescents were confidentially informed of CT/GC screening recommendations and were offered screening. If patients agreed to CT/GC testing, a clinical decision support tool was triggered to inform the provider and order testing. The main and key secondary outcomes were the proportion of CT/GC testing and positive CT/GC test results in each respective ED.ResultsBoth EDs experienced modest but statistically significant increases in CT/GC testing post- versus pre-intervention (main: 11.5% vs. 7.9%; confidence interval [CI]: 2.9–4.2; p < .0001 and satellite: 3.8% vs. 2.6%; 95% CI: .7–1.7; p < .0001). Among those tested, the positivity rate at the main ED did not significantly change post- versus pre-intervention (24.1% vs. 23.2%; 95% CI: ?1.9 to 3.8; p = .71) but significantly decreased at the satellite ED (7.6% vs. 14.8%; 95% CI: ?12.2 to ?2.2; p = .01).ConclusionsA universally offered screening intervention increased the proportion of adolescents who were tested at both EDs and the detection rates for CT/GC at the main ED, but patient acceptance of screening was low. |
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Keywords: | Adolescents Sexually transmitted infections Gonorrhea Chlamydia Screening Emergency department |
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