REPORTING FROM AAP 2017
CHICAGO (FRONTLINE MEDICAL NEWS) – Adolescents with pelvic inflammatory disease (PID) were unlikely to be screened for HIV or syphilis, and many didn’t receive an appropriate antibiotic regimen, according to a recent study reported at the annual meeting of the American Academy of Pediatrics.
Patients who were sent home rather than admitted were especially likely to miss screening, as were Hispanic patients and those with private insurance.
Although PID is known to be associated with an increased risk for HIV and syphilis, fewer than one in three PID patients aged 12-21 years received the tests. Over 80% of patients were tested for gonorrhea and chlamydia, and a similar number received a pregnancy test, according to cross-sectional data drawn from a national database over a 5-year period.
The Centers for Disease Control and Prevention strongly recommends that all women diagnosed with PID be tested for HIV, and that high-risk individuals also be tested for syphilis, wrote Amanda Jichlinski, MD, and her coauthors at Children’s National Health System, Washington.
The study, presented during a poster session, used data from the national Pediatric Health Information System database from 2010 to 2015. A total of 10,698 records with a diagnostic code for PID were included; patients were females aged 12-21 years seen in a pediatric emergency department.
In addition to the primary outcome of syphilis and HIV testing, the authors also looked at whether antibiotic administration for PID was in line with CDC recommendations – and it wasn’t. “Fewer than half of patients in the ED received antibiotic regimens adherent to CDC guidelines,” wrote Dr. Jichlinski and her coauthors.
Forty-six percent of patients received ceftriaxone and doxycycline, 21% received ceftriaxone and azithromycin, and 6% received ceftriaxone and metronidazole. Ceftriaxone monotherapy was given to 15% of patients. One in 10 patients with a PID diagnosis received no antibiotic at all; 2% of patients received some other regimen.
The researchers used multivariable analysis to examine separately which patient and hospital characteristics were associated with an increased likelihood of testing for both HIV and syphilis. With white, non-Hispanic adolescents used as the referent, Hispanic females with PID were less likely to receive screening for either HIV or syphilis (adjusted odds ratio, 0.8 for both; 95% confidence interval, 0.7-1.0 for both).
In contrast, black non-Hispanic females were screened more often; the aOR for HIV screening was 1.4 (95% CI, 1.2-1.6), and the aOR for syphilis screening was 1.8 (95% CI, 1.6-2.0) for this group of adolescents.
Patients were dichotomized into older (17-21 years of age; n = 4,737, 44%) and younger (12-16 years of age; n = 5,961, 56%) age groups; younger patients were slightly more likely to receive HIV (aOR, 1.2) and syphilis (aOR, 1.1) screening.
Just under a third of patients in the study were seen in a hospital with fewer than 300 beds, and these facilities were more likely to screen for HIV (aOR, 1.4) and syphilis (aOR, 1.1) than the larger hospitals.
Over two-thirds of patients had public insurance, and these females also were more likely to be screened for HIV and syphilis than patients with private insurance (aOR, 1.3 and 1.4, respectively). Being uninsured further upped the odds for screening to an aOR of 1.5 for HIV and 1.6 for syphilis, compared with privately insured patients.
By far the largest predictor of whether HIV and syphilis screening was done, though, was a hospital admission. Patients who were admitted (n = 4,043, 38%) were 7 times more likely to be screened for HIV and 4.6 times more likely to be screened for syphilis than those who were sent home from the emergency department.
Although the large, nationally representative study had many strengths, Dr. Jichlinski and her coauthors acknowledged that the data they were provided couldn’t account for medication that was prescribed, rather than administered in the emergency department. Also, the results may not be generalizable to adolescents treated in nonpediatric emergency departments or other facilities, such as urgent care centers.
“Adolescents with PID are underscreened for HIV and syphilis,” wrote Dr. Jichlinski and her coauthors. They called for pediatricians to receive more education about management of PID in adolescents. From a practical perspective, the investigators also suggested incorporating order sets for sexually transmitted infection testing and antibiotic administration into electronic medical records; in this way, a PID diagnosis code would trigger simplified testing and treatment choices.
Dr. Jichlinski reported no conflicts of interest. Dr. Monika Goyal, MD, senior author on the study, reported funding support by the National Institute of Child Health and Human Development. Dr. Goyal also holds an appointment at the George Washington University, Washington.
SOURCE: Jichlinski A et al. AAP 2017 Abstract 5, AAP Section on Emergency Medicine.