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Gender Differences in CDC Guideline Compliance for STIs in Emergency Departments

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Sexually transmitted infections (STIs) are a common reason for emergency department (ED) visits. The objective of this study was to determine if there were gender differences in adherence to Centers for Disease Control and Prevention (CDC) STI diagnosis and treatment guidelines, as documented by emergency providers.

Methods: We performed a retrospective chart review to identify patients treated for urethritis, cervicitis, and pelvic inflammatory disease (PID) in the EDs of three hospitals in a Pennsylvania network during a calendar year. Cases were reviewed to assess for compliance with CDC guidelines. We used descriptive statistics to assess the distributions of study variables by patient sex. In the analysis we used Student’s t-tests, chi-square tests, and logistic regression. Statistical significance was set at p ≤ 0.05.

Results: We identified 286 patient records. Of these, we excluded 39 for the following reasons: incorrect disease coding; the patient was admitted and treated as an inpatient for his/her disease; or the patient left the ED after refusing care. Of the 247 participants, 159 (64.4%) were female. Females were significantly younger (26.6 years, SD=8.0) than males (31.2, SD=11.5%), (95% confidence interval [CI] [2.0– 7.0], p=0.0003). All of the males (n=88) in the cohort presented with urethritis; 25.8% of females presented with cervicitis, and 74.2% with PID. Physician compliance for the five CDC criteria ranged from 68.8% for patient history to 93.5% for patient diagnostic testing, including urine pregnancy and gonorrhea/chlamydia cultures. We observed significant differences by patient sex. Fifty-four percent of the charts had symptoms recorded for female patients that were consistent with CDC characteristics for diagnostic criteria compared to over 95% for males, OR=16.9; 95% CI [5.9–48.4], p<0.001. Similar results were observed for patient discharge instructions, with physicians completely documenting delivery of discharge instructions to 51.6% of females compared to 97.7% of complete documentation in males, OR=42.3; 95% CI [10.0–178.6] p<0.001). We observed no significant sex differences in physician documentation for physical exam or for therapeutic antibiotic treatment.

Conclusion: This retrospective study found patient gender differences in how emergency providers complied with documenting with regard to the 2010 CDC guidelines for the diagnosis and treatment of urethritis, cervicitis, and PID. Specifically medical records of men were more likely to have complete documentation of symptoms recorded (95% CI 5.9–48.4) and to have discharge instruction documentation (95% CI 10.0–178.6) than records of women.

No MeSH data available.


2010 CDC guidelines for treatment of pelvic inflammatory disease5.CDC, Centers for Disease Control and Prevention.
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f2-wjem-18-390: 2010 CDC guidelines for treatment of pelvic inflammatory disease5.CDC, Centers for Disease Control and Prevention.

Mentions: We assessed compliance with 2010 CDC standards across five domains for cases of urethritis, cervicitis, and PID.5 The outcomes evaluated included documentation of historical and diagnostic components, diagnostic testing, treatment provided, and follow-up instructions. Specifically, for urethritis, historical components included dysuria, urethral pruritus, or discharge. Physical exam findings were discharge of mucopurulent or purulent material. Diagnostic testing included obtaining cultures for gonorrhea and chlamydia. Antibiotic regimens were compared with CDC standards (Figure 1). Proper discharge instructions required safe-sex instructions. For cervicitis, diagnostic components included having a mucopurulent or friable cervix along with a history not suggestive of PID; patients must not have experienced a history of abnormal vaginal bleeding, dyspareunia, vaginal discharge or abdominal pain. Similarly, physical exam documentation required ruling out findings for PID, including a documented fever or experiencing any tenderness of the lower abdomen, adnexa or with cervical motion. Diagnostic testing included obtaining cultures as well as a pregnancy test. Antibiotic regimens and discharge instructions were the same as for urethritis. For PID, historical components and physical exam findings applied appropriately were as listed for cervicitis above. Diagnostic testing included cultures and a pregnancy test. Antibiotic regimens were compared with CDC standards (Figure 2). Discharge instructions included safe-sex instructions, follow-up, and return instructions.


Gender Differences in CDC Guideline Compliance for STIs in Emergency Departments
2010 CDC guidelines for treatment of pelvic inflammatory disease5.CDC, Centers for Disease Control and Prevention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391888&req=5

f2-wjem-18-390: 2010 CDC guidelines for treatment of pelvic inflammatory disease5.CDC, Centers for Disease Control and Prevention.
Mentions: We assessed compliance with 2010 CDC standards across five domains for cases of urethritis, cervicitis, and PID.5 The outcomes evaluated included documentation of historical and diagnostic components, diagnostic testing, treatment provided, and follow-up instructions. Specifically, for urethritis, historical components included dysuria, urethral pruritus, or discharge. Physical exam findings were discharge of mucopurulent or purulent material. Diagnostic testing included obtaining cultures for gonorrhea and chlamydia. Antibiotic regimens were compared with CDC standards (Figure 1). Proper discharge instructions required safe-sex instructions. For cervicitis, diagnostic components included having a mucopurulent or friable cervix along with a history not suggestive of PID; patients must not have experienced a history of abnormal vaginal bleeding, dyspareunia, vaginal discharge or abdominal pain. Similarly, physical exam documentation required ruling out findings for PID, including a documented fever or experiencing any tenderness of the lower abdomen, adnexa or with cervical motion. Diagnostic testing included obtaining cultures as well as a pregnancy test. Antibiotic regimens and discharge instructions were the same as for urethritis. For PID, historical components and physical exam findings applied appropriately were as listed for cervicitis above. Diagnostic testing included cultures and a pregnancy test. Antibiotic regimens were compared with CDC standards (Figure 2). Discharge instructions included safe-sex instructions, follow-up, and return instructions.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Sexually transmitted infections (STIs) are a common reason for emergency department (ED) visits. The objective of this study was to determine if there were gender differences in adherence to Centers for Disease Control and Prevention (CDC) STI diagnosis and treatment guidelines, as documented by emergency providers.

Methods: We performed a retrospective chart review to identify patients treated for urethritis, cervicitis, and pelvic inflammatory disease (PID) in the EDs of three hospitals in a Pennsylvania network during a calendar year. Cases were reviewed to assess for compliance with CDC guidelines. We used descriptive statistics to assess the distributions of study variables by patient sex. In the analysis we used Student’s t-tests, chi-square tests, and logistic regression. Statistical significance was set at p ≤ 0.05.

Results: We identified 286 patient records. Of these, we excluded 39 for the following reasons: incorrect disease coding; the patient was admitted and treated as an inpatient for his/her disease; or the patient left the ED after refusing care. Of the 247 participants, 159 (64.4%) were female. Females were significantly younger (26.6 years, SD=8.0) than males (31.2, SD=11.5%), (95% confidence interval [CI] [2.0– 7.0], p=0.0003). All of the males (n=88) in the cohort presented with urethritis; 25.8% of females presented with cervicitis, and 74.2% with PID. Physician compliance for the five CDC criteria ranged from 68.8% for patient history to 93.5% for patient diagnostic testing, including urine pregnancy and gonorrhea/chlamydia cultures. We observed significant differences by patient sex. Fifty-four percent of the charts had symptoms recorded for female patients that were consistent with CDC characteristics for diagnostic criteria compared to over 95% for males, OR=16.9; 95% CI [5.9–48.4], p<0.001. Similar results were observed for patient discharge instructions, with physicians completely documenting delivery of discharge instructions to 51.6% of females compared to 97.7% of complete documentation in males, OR=42.3; 95% CI [10.0–178.6] p<0.001). We observed no significant sex differences in physician documentation for physical exam or for therapeutic antibiotic treatment.

Conclusion: This retrospective study found patient gender differences in how emergency providers complied with documenting with regard to the 2010 CDC guidelines for the diagnosis and treatment of urethritis, cervicitis, and PID. Specifically medical records of men were more likely to have complete documentation of symptoms recorded (95% CI 5.9–48.4) and to have discharge instruction documentation (95% CI 10.0–178.6) than records of women.

No MeSH data available.