Loading summary
Transcript4 lines
- [00:00]
A
Foreign. Welcome to the pit.
- [00:08]
B
We got two traumas from the tea five minutes out.
- [00:10]
A
Okay, copy that. Actually, this is the most important person that you're going to meet today. This is Dana, she's our charge nurse.
- [00:16]
B
All right, podcast family. Let me just go back two years to June of 2024. That's almost exactly two years ago from when we were recording this episode. Back then we highlighted a very surprising publication from JAMA Network Open regarding adolescent care in the emergency department. Now, it's not surprising that many adolescents use the ed, unfortunately, as their primary care provider, but it does highlight the fact that that's a perfect opportunity because they are seeing a healthcare provider to have contraceptive needs addressed. However, that's not what was happening. That publication again was from two years ago and it showed significant gaps in addressing contraception in the ED for pregnancy vulnerable young women, mainly teens. Now, we covered those results back then and said that would be a wonderful QI project for any resident or medical student to work with in their hospital emergency room department or their ED lead to try to improve that. Well, now a similar publication looking at a different target, this time looking at STI empiric treatment, has been published and through the ED perspective, let me explain. Now, the thought process here is that women would have STI treatment, whether it's truly diagnostic and they're going in for treatment or as imperative treatment. Like we think you've got an STI based on your symptoms and or possible exposure, so we're going to treat you. We would think that that treatment would be the same whether a patient was pregnant or not. However, that's not, once again, what is being seen here. So there's a big discrepancy in what pregnant women are given or in this case not given in the ED compared to their non pregnant peers. Now, this publication also came out of, oddly enough, JAMA Network Open and it came out in mid April of 2026. Now, there's some big questions that remain unanswered in the data and we're going to cover that in this episode. But it's a good reminder that which is a vital part of patient contact. That's why it's the pit. You got to pass through the pit to get through the rest of the hospital. They are the doorkeepers for the majority of admissions. Unless you're doing a direct admission from a clinic or from an outside source, the Pit, for lack of a better name, is vital here. And so what happens in the pit really helps direct future patient care. So this is going to show a Big discrepancy, guys. With STI empiric treatment between pregnant and non pregnant populations again in JAMA Network open from mid April 2026. I think I've set it up enough. We will be right back. We're just trying to fulfill our life calling and our mission. This is Dr. Chapa's OB GYN no Spin podcast. I gotta be honest, I'm not sure why people get so pissy about the term the Pit. Even in the show the Pit, one of the hospital administrators was like, you've got to change. You know how you call this place? You know the Pit is derogatory. It's the pit. It is what it is. Actually it was a badge of honor. A second year resident who run Parkland had has divided er. So in other words, internal medicine, surgery, you know, trauma, obgyn, women's health, there's an ICC and immediate care area that's a kind of a separate ed and so residents staff their own. So the second year resident who manned that, I mean it was a badge of honor. You're the pit boss, baby. The pit boss. Anyway, the Pit, it is what it is. I have no problem with the Pit. I think the name should stay the Pit. But that publication from 2024 that we talked about addressing, you know, when an adolescent goes to the for foot sprain, whatever, it doesn't matter. We should really talk to them. Especially for the for women. Because men or young men, you know, there's only one contraception, which is condoms. And we should still talk to them and, or give them condoms. But for young women, we should at least ask, hey, are you sexually active? And are you taking care of yourself? And here's maybe a prescription for birth control. I don't know, something, but it's not being done. It's like, hey, you came in for your ankle xyz, your ankle is fixed, yada yada, a couple of pins together. Not really, but you know what I mean, A couple of bandages together and off you go. And never the word of contraception spoken. Well, that was by a group of authors that's completely different from this new group of authors which is from mid April of 2026. So it's, it's odd, isn't it that that was around the same time two years ago and now in this time, and just by point of reference for doing this at the end of May 2026, although it will likely come out somewhere in the first week ish of June of 2026, it's been two years apart. Okay, so one is looking for discrepancies in contraceptive access in the ED. And I get the rebuttal, guys, I get it. Hey, we're not a clinic, you know, we're not a, you know, a Title 10 clinic or whatever, you know, giving birth control. We're here for emergency issues. I get that. However, I mean, we're still healthcare providers, and we still need to meet the needs especially of sexually active and pregnancy vulnerable women to say, do you want some birth control? I'm all for that. Okay. Obviously, though, I'm biased as a women's healthcare provider. Well, now we're gonna turn the flavor. Now, looking at pregnant women and those who have a need for an STI treatment and how they were treated or not treated compared to their non pregnant cohort. All right, Interesting, interesting, interesting. This came out mid April 2026, under the banner of JAMA Network Open of Infectious Diseases. This was a retrospective cohort study. Use epic. We do use EPIC as well. So epic's just kind of ubiquitous, I guess. I don't know. Some places don't. I mean. I mean, so I gotta be honest. We use EPIC in one location, another location. So it uses Meditech, although it's converting, of course, to epic. So they used EPIC to go do this retrospective cohort study. And it looked at ED encounters where patients received testing for gonorrhea or chlamydia between January 2016 and December 2024. So it spanned the COVID era. Okay. Now, this analysis focused on comparing empiric treatment. In other words, without a diagnosis, just like, oh, you've got mucopyrine survicitis. You should probably get. Take something for that in the pregnant cohort compared to the non pregnant cohort and to see who got empiric treatment. Remember, empiric? This is not diagnostic. Okay, so this is not those who. Just to clarify, not those who have a working diagnosis. If they came in and said, hey, somebody called me and said, my dude's got something and we're having sex. You need to give me something that. That's different. This is empiric treatment. Okay, so suspected, either clinically or by history, I guess suspected sti, but not truly confirmed. Okay? Now only EPIC can look at 4.9 million. Yeah, 4.9 million with an M million ed encounters. Because it's all one big, you know, data mining site. That's a one plus of epic. It's a little scary that you can get that much data out of one, you know, patient network. But whatever. It is what it is. So it analyzed 4.9 million ED encounters where patients who are, who were tested for neisseria, gonorrhea or chlamydia received treatment. Now here's the catch. We're just gonna do this quickly. Guys, my point is, here's a take home message. Talk to your ED peeps, talk to the people in the pit and say, fear not the pregnant woman, fear not the teen who's sexually active and pregnancy vulnerable. You gotta talk to them and you gotta take care of them correctly. Here it is. Among pregnant patients, only 10.9% received empiric treatment during that ED visit, compared to 38.2% of their non pregnant cohort. So, yeah, three times more in the non pregnant cohort received some kind of treatment. And the gap remained stable over time. Meaning it wasn't a Covid issue. It wasn't. Maybe the ER attending, you know, in years, whatever. 2016 to 2018. And then things got better from 18 to 24. No, no, the gap remains stable. Like, ah, we're not touching the pregnant woman. She's got some weird funky discharge. That's for her OBGYN to figure out and adios. Adios. No, no, you gotta treat them. But there is this weird fear of giving maybe a pregnant patient the wrong medication, which I respect. Or I'm not treating it correctly, which I respect. That's a phone call, baby. And there's something that's very helpful called Google. I mean, not that we should be using Google for medical decisions, but if in a bind, you can go to the CDC website and look at STI treatment guidelines. Guys, these are not hard to figure out. There's plenty of ways to look for. What is the standard treatment for suspected gonorrhea? Clin, chlamydia. And get these patients treated. So in the pregnant cohort, 10.9% compared to 38.2% received treatment. Now here's why this matters. We know that untreated gonorrhea. We know that untreated chlamydia in pregnancy, not good. Both of them linked to preterm birth, spontaneous miscarriage in the first trimester, stillbirth at time. It is potential with severe iai, neonatal conjunctivitis, neonatal pneumonia, especially for chlamydia. These are big deals. We're not addressing this. When they come in to the ed. That's why it's a good medical student or a resident QI project. So contact your, your friendly ED person and go. I think we need to take a look at this. Just do a, a, a data query. For in this case, you know, pregnant women from anywhere from 18 to whatever it is, 35 years of age, whatever you want to do, and see how you can improve STI treatment in that population. I think this is a pretty valid QI project. Now, the authors suggest that this discrepancy reflects a complex quote, complex interplay, end quote. It's always a complex interplay. Now, I'm not making fun of that. I mean, the truth is, it's true, but it's a complex interplay of factors rather than clinician bias alone. Okay. Pregnant patients can be assumed to have reliable prenatal care. So they're like, usually like, hey, just go see your doctor. And that's a big assumption. Never assume. Especially in these times where insurances, you know, kind of fall or drop off or something's uncovered. If you have an opportunity to treat them, then they should be treated at that time. But there are two big questions in this data that are unanswered. Okay, I'm going to get to this, then we're going to be done. Two big questions here. The first is, what were the presenting signs or symptoms for these patients and why were they, you know, getting screened for gonorrhea and chlamydia? Was it just random or. Or was there a specific concern? And if there's a concern that why not get empiric treatment? Why not? I mean, so what's the issue? So that's not covered. What were the presenting signs and symptoms in these two cohorts, pregnant and non pregnant? And then the second question is, wouldn't it have been nice? Guys, let's look at this here. Here's how I would improve this study. Why not do a sub analysis not just on pregnant versus non pregnant, but pregnant based on subanalysis on ega. In other words, are they less likely to treat a patient in the first trimester than in the third trimester? Or they're more likely to treat them in the second trimester, the sweet spot. What does that look like? That was not covered. So those are the two questions that I have. What were the presenting signs or symptoms? And second, what would that have looked like if they broke up the entire pregnancy bucket into specific EGA subclasses? Because that wasn't done. So I don't know. These are two questions that weren't in the publication. I wish there were. I have thoughts. Maybe that the reason that they were screened for gonorrhea and chlamydia specifically is that maybe they had symptomatic presentations, which is even bigger gap, because if they're symptomatic. They should have some kind of treatment. Maybe there were sexual assault evaluations. Maybe they went into like, hey, can you start me some kind of prenatal care? I don't know. That could be a thing. Maybe it was a partner notification, as we said. Hey, you know, my dudes got something and I came in for treatment. I don't know. None of those reasons were in there. That's a gap in the data. So if you want to do this in your academic institution, I'd advise you look that data up. Why were you screened? I mean, obviously there's a reason. If some pregnant patient goes into the ED for heartburn and you end up with a gonorrhea and chlamydia culture, you're either really damn thorough, which is great, although it's kind of weird. But why? Unless they said, hey, I'm having weird discharge in it to be checked. Okay, now let's check that box and give an idea. Some kind of diagnostic code that would justify that test. Okay, so very quick, this is just a. Again, we're trying to do these very quickly because it's. It's pretty much not on the heels, but very much in line with the June of 2024 publication that says that EDS, the pits. The pit is not really addressing birth control in teens. Well, this one is saying that in mid April of 2026, we' really addressing STIs in the ED in our pregnant patients. It's actually a third who had treatment compared to the non pregnant cohort. Crazy, crazy, crazy. The title of this publication, guys, is Sexually Transmitted Infection Treatment Rates among Pregnant and Non Pregnant Patients in Emergency Departments. Again, JAMA Network open Podcast family, as always, we're thankful for you. We're glad you're part of our podcast community. Go talk to your friendly neighborhood ED physician and say, let's try to work this out Podcast family. We'll see you on another episode of the OB GYN no Spin podcast. This is Dr. Chapa's OB GYN no Spin podcast.