Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Sexually transmitted infections (STIs) are a common reason for Emergency Department (ED) visits.  The objective of this study was to see if there were gender differences in CDC diagnosis and treatment guidelines as documented by emergency physicians.

Methods: A retrospective chart review was performed to idenitfy patients treate for urethritis, cervicitis, and PID in the EDs of three hospitals in a PA network during a calendar year.  Cases were reviewed to assess for compliance in documentation with CDC guidelines. Descriptive statistics were used to assess the distributions of study variables by patient sex.  Student t-tess, chi-square tests, and logistic regression were used in the analysis.  Statistical significance was set at p less than or equal to 0.05.

Results: 286 patient records were identified, of these 39 were excluded due to incorrect disease coding, the patient was admitted and treated as an inpatient for their disease, or the patient left the emergency department after refusing care.  Of the 247 participangs, 159  (64.4%) were female.  Females were significantly younger (26.6 years, SD=8.0) than males (31.2, SD=11.5%), (95%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 75.2% with PID. Compliance with documentation for the 5 CDC criteria ranged from 68.8% for patient history to 93.5% for patient diagnostic testing including urine pregnancy, and gonorrhea/chlamydia cultures. Significant differences were obesrved by patient sex.  54% of the charts had symptoms recorded for female patients that were consistent with CDC characteristics for diagnostic critera compared to over 95% for males , (OR=16.9, 95% CI 5.9-48.4, p less than 0.001). Similar results were observed for patient discharge instructions, with physicians completely documenting deliver of discharge instructions to 51.6% females compared to 97.7% of complet documentation in males OR=42.3;95%CI;10.0-178.6, p <0.001). No significant sex differences in documentaion were observed for exam or fo therapeutic antibiotic treatment. Conclusion: This retrospective study found patient gender differences in documentaiton compliance with CDC guidelines for the diagnosis and treatment of urethritis, cervicitis and PID