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Walden J, Stanek JR, Ebersole AM, Nahata L, Creary SE. Sexually transmitted infection testing and diagnosis in adolescents and young adults with sickle cell disease. Pediatr Blood Cancer 2024:e31240. [PMID: 39099153 DOI: 10.1002/pbc.31240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/29/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are common and disproportionately affect Black adolescents and young adults (AYAs). Less is known about STIs among Black AYAs with chronic conditions, such as sickle cell disease (AYAs-SCD). This study compared STI testing and diagnosis between AYAs-SCD and their peers, overall and among STI-related encounters. PROCEDURE This retrospective, cross-sectional study used diagnosis and billing codes in the Pediatric Health Information System (PHIS) to identify inpatient and emergency department encounters from January 1, 2022 to May 31, 2023 among all AYAs 15-24 years and those with STI-related diagnoses (e.g., "cystitis"). STI testing and diagnosis rates were compared between AYAs-SCD, non-Black AYAs, and Black AYAs, controlling for age, sex, and encounter setting. RESULTS We identified 3602 AYAs-SCD, 177,783 Black AYAs, and 534,495 non-Black AYAs. AYAs-SCD were less likely to be tested for STIs than non-Black AYAs (odds ratio [OR] = 0.26; adj. p < .001) and Black AYAs (OR = 0.53; adj. p < .001). When tested, AYAs-SCD were more likely to be diagnosed with an STI than non-Black AYAs (OR = 2.39; adj. p = .006) and as likely as Black AYAs (OR = 0.67; adj. p = .15). Among STI-related encounters, AYAs-SCD were less likely to be tested than non-Black AYAs (OR = 0.18; adj. p < .001) and Black AYAs (OR = 0.44; adj. p < .001). No significant differences in STI diagnoses were found in this subset between AYAs-SCD and non-Black AYAs (OR = 0.32; adj. p = .28) or Black AYAs (OR = 1.07; adj. p = .99). CONCLUSIONS STI care gaps may disproportionately affect AYAs-SCD. STIs should be considered when evaluating symptomatic AYAs-SCD in acute settings. More research is needed to further contextualize STI care for AYAs-SCD.
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Affiliation(s)
- Joseph Walden
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Columbus, Ohio, USA
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ashley M Ebersole
- Division of Adolescent Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leena Nahata
- Abigail Wexner Research Institute, Center for Biobehavioral Health, Columbus, Ohio, USA
- Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Susan E Creary
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Columbus, Ohio, USA
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Bronzo A, Insley E, Yellin S, Toledano VL, Dahan N. The Great Mimicker: Secondary Syphilis-Associated Nephrotic Syndrome in an Adolescent Patient. J Emerg Med 2024; 66:e720-e722. [PMID: 38763837 DOI: 10.1016/j.jemermed.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/07/2023] [Accepted: 01/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Syphilis is long regarded as the "great mimicker" for its variety of symptoms and clinical manifestations. Rarely, it can present with renal involvement, particularly nephrotic syndrome. This is an uncommon initial presentation, particularly in pediatrics. CASE REPORT We present the case of a 17-year-old male adolescent who presented to the emergency department with a chief symptom of abdominal pain. In addition, he was found to have a number of stigmata characteristic of both syphilis and nephrotic syndrome, including a rash and diffuse edema, particularly in the lower extremities. This led to the diagnosis of nephrotic syndrome secondary to syphilis infection. Prompt diagnosis and treatment of syphilis resulted in resolution of both kidney injury and symptoms of the underlying infection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the variety of manifestations of sexually transmitted infections, particularly in the pediatric population. It demonstrates how identifying syphilis as the inciting event led to the correct treatment management for the patient. This presentation serves to teach and remind emergency physicians of the wide-ranging presentations for sexually transmitted infections, particularly syphilis, and the necessity of obtaining a sexual history even in adolescent patients.
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Affiliation(s)
- Alexander Bronzo
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Elena Insley
- NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Sharon Yellin
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | | | - Nessy Dahan
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
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Mukherjee G, Zhang C, Kandaswamy S, Gooding H, Orenstein E. Current Inpatient Screening Practices for Sexual History and STIs: An Opportunity to Seize. Clin Pediatr (Phila) 2024; 63:350-356. [PMID: 37424327 DOI: 10.1177/00099228231183501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The American Academy of Pediatrics recommends utilizing hospitalizations as an opportunity to provide sexual health screenings for adolescents. This study aimed to describe the current practice of sexual history documentation (SHxD) and sexually transmitted infection (STI) testing among adolescents admitted to a pediatric hospital medicine service. Retrospective cross-sectional study of adolescents (14-19 years old) admitted to the PHM service from 2017-2019 was performed at an academic children's health system. Patient (demographics, history of complex chronic condition, and insurance), hospitalization (length of stay, diagnosis, STI tests ordered/results), and physician (level of training and gender) characteristics were extracted for each encounter. A natural language processing algorithm identified the presence of SHxD. Univariate analysis and multivariable analysis were performed to detect factors associated with SHxD and STI screening. The prevalence of STIs was calculated for those who were tested. Out of 2242 encounters, SHxD and STI testing rates were 40.9% and 17.2%, respectively. Patient gender, race, lack of complex chronic condition, and resident involvement were predictive of SHxD and STI testing. SHxD increased the odds of STI testing significantly (OR 5.06, CI 3.90-6.58). Among those who were tested, the prevalence of STIs was highest for chlamydia (37/329, 11.2%). Overall, sexual health screening rates remain low in the hospital setting and future improvement initiatives are needed.
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Affiliation(s)
- Gargi Mukherjee
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
| | - Chao Zhang
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
| | - Swaminathan Kandaswamy
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
| | - Holly Gooding
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
- Department of Pediatrics, Emory University/Grady Memorial Hospital, Atlanta, GA, USA
| | - Evan Orenstein
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
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Vayngortin T, Gracia M, Clark K, Vayngortin B, Bialostozky M, Heitzman L, Hollenbach K, Kumar M, Titchen K, Bryl A. Increasing Chlamydia and Gonorrhea Testing for Adolescents in the Pediatric Emergency Department. Pediatrics 2024; 153:e2022059707. [PMID: 38053440 PMCID: PMC11022968 DOI: 10.1542/peds.2022-059707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE Adolescents who use the emergency department are more likely to engage in high-risk sexual activity and are at an increased risk of sexually transmitted infections. We aimed to increase testing for Chlamydia and gonorrhea from 12% to 50% among adolescents presenting to our pediatric emergency department with at-risk chief complaints over 12 months. METHODS Plan-Do-Study-Act cycles were initiated in July 2020. A multidisciplinary team reviewed preexisting data and developed interventions to increase Chlamydia and gonorrhea testing in teens with at-risk complaints, including genitourinary and behavioral health complaints, and females with abdominal pain. Two categories of interventions were implemented: education and electronic medical record optimization. Process measures were the proportion of patients with a documented sexual history and the proportion of patients tested with a documented confidential phone number. Secondary outcome measures included the weekly number of positive test results and the proportion of patients testing positive who were contacted to arrange treatment. Statistical process control charts were used to examine changes in measures over time. RESULTS Within 14 months of project initiation, the proportion of at-risk patients tested increased from 12% to 59%. Teen phone number documentation remained unchanged from 23%. Sexual history documentation remained unchanged from 46%. The number of positive test results increased from 1.8 to 3.4 per month, and the proportion of patients testing positive who were contacted to arrange treatment remained unchanged at 83%. CONCLUSIONS We surpassed our goal and increased the proportion of at-risk patients tested for Chlamydia and gonorrhea to 59%, sustained for 4 months from the last intervention.
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Affiliation(s)
- Tatyana Vayngortin
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Michael Gracia
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Katie Clark
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Beata Vayngortin
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Mario Bialostozky
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Lindsay Heitzman
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, California
| | - Kathryn Hollenbach
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Maya Kumar
- Division of Adolescent Medicine, Rady Children’s Hospital San Diego, San Diego, California
| | - Kanani Titchen
- Division of Adolescent Medicine, Rady Children’s Hospital San Diego, San Diego, California
| | - Amy Bryl
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
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Vayngortin T, Clark K, Hollenbach K. Sexual History Documentation and Screening in Adolescent Females with Suicidal Ideation in the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13018. [PMID: 36293599 PMCID: PMC9603263 DOI: 10.3390/ijerph192013018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Adolescents with mental illness often seek care in the emergency department (ED) and are more likely to engage in risky behaviors such as substance abuse and unprotected sex, increasing their risk of sexually transmitted infections (STI), unintended pregnancy, and non-consensual sex. This was a retrospective study of 312 females, aged 13-17 years, presenting to the pediatric ED with the chief complaint of suicidal ideation from February to May 2018. Electronic medical records were reviewed for demographics, psychiatric history, sexual history, and testing for pregnancy or STI. The primary outcome was the documentation of the presence or absence of prior sexual activity. Secondary outcomes included documented aspects of sexual history and pregnancy or STI testing performed in the ED. Of the 312 eligible patients, 144 (46.2%) had a documented sexual history, and of those 50 (34.7%) reported being sexually active. Sexual history documentation was not associated with patient age, race, ethnicity, insurance, or the gender of the ED provider. A history of anxiety and a recent suicide attempt were associated with a lack of sexual history documentation (p = 0.03). Of the sexually active patients, 28 (56%) had documentation of contraception use. Pregnancy testing was performed in 67.3% of all patients and 80% of sexually active patients. Only 10 patients had STI testing in the ED, with most testing occurring in those with sexual history documentation (p = 0.007). In conclusion, more than half of females with suicidal ideation in our ED had no documentation of sexual history, and when documentation was completed, it was often missing important elements, including screening for pregnancy, STI, non-consensual sex, and contraception use. Since the ED visit provides an important opportunity to address the reproductive health needs of this high-risk population, further work is needed to determine ways to improve provider documentation and sexual health screening.
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Affiliation(s)
- Tatyana Vayngortin
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, CA 92123, USA
- Department of Pediatrics, San Diego School of Medicine, University of California, La Jolla, CA 92093, USA
| | - Katie Clark
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, CA 92123, USA
| | - Kathryn Hollenbach
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, CA 92123, USA
- Department of Pediatrics, San Diego School of Medicine, University of California, La Jolla, CA 92093, USA
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Robertson C, Mukherjee G, Gooding H, Kandaswamy S, Orenstein E. A method to advance adolescent sexual health research: Automated algorithm finds sexual history documentation. Front Digit Health 2022; 4:836733. [PMID: 35937421 PMCID: PMC9354080 DOI: 10.3389/fdgth.2022.836733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background:We aimed to develop and validate a rule-based Natural Language Processing (NLP) algorithm to detect sexual history documentation and its five key components [partners, practices, past history of sexually transmitted infections (STIs), protection from STIs, and prevention of pregnancy] among adolescent encounters in the pediatric emergency and inpatient settings.MethodsWe iteratively designed a NLP algorithm using pediatric emergency department (ED) provider notes from adolescent ED visits with specific abdominal or genitourinary (GU) chief complaints. The algorithm is composed of regular expressions identifying commonly used phrases in sexual history documentation. We validated this algorithm with inpatient admission notes for adolescents. We calculated the sensitivity, specificity, negative predictive value, positive predictive value, and F1 score of the tool in each environment using manual chart review as the gold standard.ResultsIn the ED test cohort with abdominal or GU complaints, 97/179 (54%) provider notes had a sexual history documented, and the NLP algorithm correctly classified each note. In the inpatient validation cohort, 97/321 (30%) admission notes included a sexual history, and the NLP algorithm had 100% sensitivity and 98.2% specificity. The algorithm demonstrated >97% sensitivity and specificity in both settings for detection of elements of a high quality sexual history including protection used and contraception. Type of sexual practice and STI testing offered were also detected with >97% sensitivity and specificity in the ED test cohort with slightly lower performance in the inpatient validation cohort.ConclusionThis NLP algorithm automatically detects the presence of sexual history documentation and its key components in ED and inpatient settings.
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Affiliation(s)
- Caryn Robertson
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Gargi Mukherjee
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- *Correspondence: Gargi Mukherjee
| | - Holly Gooding
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Grady Memorial Hospital, Atlanta, GA, United States
| | - Swaminathan Kandaswamy
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Evan Orenstein
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
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