(69) Management of Acute Pelvic Pain in Adolescent and Young Adult Females Presenting to the Emergency Department

Background: Acute pelvic or abdominal pain in adolescent females is a leading cause of presentation to emergency departments. Prior studies provide emerging evidence of racial disparities in the evaluation and management of pediatric patients who present for pain. This study seeks build on this literature to determine if there are racial disparities in the diagnostic assessment and management of young females who present to a tertiary academic center with acute pelvic or abdominal pain.

Methods: The study team conducted a review of the electronic medical records of female patients, aged 11-24, who initially presented for a chief complaint of abdominal or pelvic pain between 2016 and 2021. We employed a disproportionate stratified sampling strategy to achieve a racially balanced sample for initial, unweighted analyses. Descriptive statistics were calculated for each variable of interest. For continuous variables, mean, standard deviation (SD), and range are presented. For categorical variables, counts and proportions are presented. Descriptive statistics are also presented for the five outcomes of interest. Chi-square tests of association were fit for each of the outcomes of interest, by race.

Results: We achieved a sample of 730 patients identified as either “White” or “Black” (includes bi- and multi- racial Black/African American)” in their electronic medical records (n=730). Table 1 reports patient demographic data. Table 2 reports narcotic use, ultrasound imaging, and gynecology consults by race. There were statistically significant differences by race in narcotic orders (p < 0.05), surgical interventions < 0.001), and ultrasound utilization < 0.001) during the ED workup. Differences in after-visit narcotic prescriptions and the use of gynecology consults did not rise to the level of significance.

Conclusions: Results indicate that there may be significant racial disparities in the management and treatment of acute pelvic pain in females who present to the ED by race. Black patients receive fewer narcotics, fewer ultrasound evaluations, and fewer surgical interventions compared to white patients. Future analyses will reweight the sample and control for potential confounding variables. Gynecologic consultation is rarely utilized in the ED for acute pain episodes.