Gender Differences in CDC Guideline Compliance for STIs in Emergency Departments

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 eme...

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Bibliographic Details
Published in:The western journal of emergency medicine 2017-04, Vol.18 (3), p.390-397
Main Authors: Kane, Bryan G, Guillaume, Alexander W D, Evans, Elizabeth M, Goyke, Terrence E, Eygnor, Jessica K, Semler, Lauren, Dusza, Stephen W, Greenberg, Marna Rayl
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Centers for Disease Control and Prevention (U.S.)
Emergency Service, Hospital
Endemic Infections
Female
Guideline Adherence - statistics & numerical data
Guidelines as Topic
Humans
Male
Patient Compliance - statistics & numerical data
Patient Discharge
Patient Education as Topic
Pennsylvania - epidemiology
Retrospective Studies
Sex Factors
Sexually Transmitted Diseases - drug therapy
Sexually Transmitted Diseases - prevention & control
United States
Young Adult
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Summary: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. 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. 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
ISSN:1936-900X
1936-9018
DOI:10.5811/westjem.2016.12.32440