Abstract Number: PB0778
Meeting: ISTH 2021 Congress
Background: Twenty percent of females presenting with abnormal uterine bleeding (AUB) may have an underlying bleeding disorder. For many, AUB is their initial presenting symptom. Prior work evaluating the inpatient management of adolescents admitted for AUB found that Black and Hispanic girls were overrepresented and that hemostatic evaluations were inconsistent. Patterns of emergency care in these patients have not been well studied.
Aims: 1. Assess patterns in hematologic evaluation of girls presenting to the emergency department (ED) with AUB.
2. Determine if girls from racial minority groups are disproportionately over-represented within this population.
Methods: This was a retrospective study utilizing the Pediatric Health Information System (PHIS) database, which contains clinical and resource utilization data for 51 children’s hospitals in the United States. ED encounters from October 2015-September 2020 for females 8-21 years with a diagnosis code of AUB were evaluated. Demographic information, additional diagnostic codes, and laboratory evaluations were collected. Data were descriptively summarized, and comparisons made using nonparametric methods.
Results: During the study period, 24,091 unique patients with AUB were seen in the ED; 24.8% were admitted and excluded from further analysis. Median age was 16.3 years (IQR 14.1-17.8 years). Despite comprising only 25% of all ED encounters in PHIS during the study period, Black girls accounted for 34.4% of AUB encounters (Table 1). Return ED visits were common (17.1% returning within 30 days; 28.0% returning within 90 days). Most encounters (65.1%) included evaluation for anemia versus only 6.9% for iron deficiency and 26.6% for hemostatic disorders. Laboratory evaluations differed in White versus Black females (Table 2).
| Characteristic | N (%) |
| Unique Patients | 18,160 |
| Race | |
| White | 7,160 (39.4) |
| Black | 6,238 (34.4) |
| Other/Unknown | 4,762 (26.2) |
| Presenting Symptoms | |
| Abdominal pain | 3,755 (20.7) |
| Headache | 924 (5.1) |
| Dizziness | 877 (4.8) |
Table 1. Patient Demographics
| Lab Evaluation | All Patients n = 18,160 |
White Patients n = 7,160 |
Black Patients N = 6,238 |
p-value |
| CBC or Hemoglobin | 11,902 (65.5) | 4,995 (69.8) | 3,669 (58.8) | < .001 |
| Any Iron Evaluation | 1,251 (6.9) | 568 (7.9) | 373 (6.0) | < .001 |
| Prothrombin Time/Partial Thromboplastin Time | 4,597 (25.3) | 2,061 (28.8) | 1,238 (19.8) | < .001 |
| Fibrinogen | 774 (4.3) | 325 (4.5) | 228 (3.7) | 0.010 |
| Von Willebrand Antigen | 1,584 (8.7) | 765 (10.7) | 404 (6.5) | < .001 |
| Von Willebrand Ristocetin Cofactor Activity | 1,553 (8.6) | 692 (9.7) | 429 (6.9) | < .001 |
| Factor VIII (Assay or Antigen) | 1,700 (9.4) | 821 (11.5) | 438 (7.0) | < .001 |
| Platelet Aggregation | 240 (1.3) | 110 (1.5) | 63 (1.0) | 0.007 |
| Other Factor Assays (II, V, VII, IX, X, XI, XII, XIII) | 47 (0.3) | 18 (0.3) | 13 (0.2) | 0.610 |
Table 2. Racial disparities in frequency of laboratory evaluations
Conclusions: In a national cohort of pediatric patients presenting with AUB to the ED, most were evaluated for anemia and one-fourth for an underlying hemostatic disorder. Black girls were overrepresented in this population and less likely to have hematologic evaluations performed.
To cite this abstract in AMA style:
Kendel N, Stanek J, Haamid F, Powers J, O'Brien S. Emergency Department Care in Pediatric and Adolescent Patients Presenting with Abnormal Uterine Bleeding [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/emergency-department-care-in-pediatric-and-adolescent-patients-presenting-with-abnormal-uterine-bleeding/. Accessed June 25, 2022.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/emergency-department-care-in-pediatric-and-adolescent-patients-presenting-with-abnormal-uterine-bleeding/