171 - Documentation of pregnancy options counseling in pediatric emergency department and outpatient general pediatric clinic visits: A retrospective study at one tertiary-care pediatric center

Poster Number: 171
Publication Number: 171.442

Background: Providing pregnancy options in the event of a positive pregnancy test during a visit is standard of care for patients. Understanding pregnancy options counseling could help to understand pregnancy options and decisions made by adolescents in the event of a positive pregnancy test.

Objective: To quantify documentation of pregnancy options counseling in pediatric emergency department and outpatient general pediatric clinic visits at one tertiary-care pediatric center.

Design/Methods: We obtained a list of encounters from 1/1/2014 through 6/1/2021 in which a positive urine pregnancy test was documented using a data abstraction service. Two investigators manually reviewed documentation of outpatient general pediatrics clinic visits, and emergency department visits including review of discharge materials and follow up visits. A senior co-investigator adjudicated any discrepancies of interpretation. We excluded encounters where patients were admitted or referred/transferred to another emergency department, and outpatient visits where patients did not see a physician or advanced practice practitioner. We calculated percent agreement and kappa between raters. We calculated descriptive statistics and multivariable logistic regression for key outcomes.

Results: There were 139 encounters with a positive urine pregnancy test. One was excluded due to being a nurse-only visit, and 50 were excluded due to patients being admitted for inpatient care or referred/transferred to an emergency department, leaving 88 encounters (Demographics: Table 1). Fifty-one (57.95%) patients were seen in the emergency department and 37 (42.05%) were seen in outpatient general pediatrics. Pregnancy options counseling was documented in 20 encounters (22.73%), including in 6/51 (11.76%) of pediatric emergency department visits and 14/37 (37.83%) of outpatient general pediatrics visits. In a logistic regression model evaluating whether options counseling was documented for the encounter, accounting for patient age, race, insurance type, practice setting, and whether the patient reported prior knowledge of the pregnancy, the only statistically significant predictor of documentation of options counseling was the practice setting (with OR of 4.80 with 95% CI (1.52, 15.18) for counseling occurring in the general pediatrics clinic compared to the pediatric emergency department, p=0.008).

Conclusion(s): Rates of documentation of pregnancy options counseling in pediatric settings are low and are lower for the pediatric emergency department compared to the outpatient general pediatrics clinic setting.