Assistant Professor of Pediatrics Nationwide Children's Hospital Columbus, Ohio, United States
Background: Sexually transmitted infections (STIs) are a public health concern for adolescents and young adults, as those aged 15-24 years represent half of all STIs diagnosed annually. Trichomonas (TV) is an STI linked with increased risk for HIV and premature births. However, rates of TV testing, even among patients at high-risk for STI, tend to be low. Objective: To assess the impact of computerized decision support (CDS) for gonorrhea (GC) and chlamydia (CT) screening in pediatric emergency departments (PEDs) on TV testing and positivity rates. Design/Methods: This was a planned, secondary analysis of a prospective pragmatic clinical effectiveness trial comparing universally-offered to targeted GC/CT screening through implementation of tablet-based sexual health surveys to drive electronic health record (EHR) embedded CDS for STI screening for patients 15-21 years across 6 PED. CDS alerts recommended GC/CT testing for those screening high or at-risk during the targeted phase and among those who requested screening during the universally offered phase. Rates of TV testing and positivity were compared among those whom a CDS tool fired vs. those who did not during the implementation phases of the study. Multivariable logistic regression was used to test for effects of interest while controlling for site and demographic variables. Results: There were 97,292 patients seen across six sites during the study period; 4,175 patients (4.2%) were tested for Trichomonas, with 301 testing positive (7.2%). TV testing rates were lower in the post-survey implementation period (OR 0.88, 95% CI 0.81, 0.96) compared with the baseline period. (Table 1) Those who had a CDS alert had 6.35 (95% CI 5.64, 7.13) times higher odds of being tested for TV, without a difference in positivity (OR 0.77; 95% CI 0.46, 1.23). Among those with a CDS alert, patients in the universal phase had 3.53 times higher odds of being tested (CI 2.58, 4.86) without a difference in positivity rates (OR 0.93, 95% CI 0.34, 2.38) as compared to those during the targeted period. In the targeted testing phase, those who were identified as at-risk or low-risk on the sexual health survey had lower testing rates compared to the high-risk group (at-risk OR 0.47, 95% CI 0.34, 0.62; low-risk OR 0.09, 95% CI 0.06, 0.12,).
Conclusion(s): CDS alerts for GC/CT testing resulted in higher TV testing rates. Using an integrated EHR CDS tool may aid in increasing TVtesting and should be expanded to identify and treat these infections in the PED.
