Documentation of Sexual and Menstrual Histories for Adolescent Patients in the Inpatient Setting.

Abstract:

STUDY OBJECTIVE:In this study, we aimed to determine the frequency of menstrual history and sexual history documentation in the inpatient setting. DESIGN, SETTING, AND PARTICIPANTS:A retrospective chart review was conducted for 307 female patients ages 11-18 years admitted from the emergency department at a single institution within a 7-month period. These charts were reviewed for documentation of menstrual and sexual history. INTERVENTIONS AND MAIN OUTCOME MEASURES:Rates of menstrual and sexual history documentation were compared according to patient age, chief complaint, admitting specialty, and medical complexity. RESULTS:Sexual history documentation was noted in 158 (45.9%) of the 344 reviewed charts. Sexual history documentation rates were higher for patients with mental health symptoms (62.9%; 61 of 98 charts; P = .02) and lower for patients admitted to surgical services (30.6%; 19 of 62 charts; P = .04). At least 1 aspect of menses was documented in 113 (32.8%) of the 344 reviewed charts. Last menstrual period was the most commonly documented aspect of menstrual history, appearing in 100 (29.1%) of the 344 reviewed charts. Menarche (4.4%; 15/344), menses frequency (7.0%; 24/344), menses duration (2.6%; 9/344), flow quantity (4.9%; 17/344), and dysmenorrhea (4.4%; 15/344) were rarely documented, regardless of chief complaint or admitting service. Menstrual history documentation rates were significantly higher for patients requiring a gynecology consultation (73.3%; 11 of 15 charts; P < .01). CONCLUSION:Menstrual and sexual history documentation rates for adolescent patients requiring inpatient admission were low, with fewer than half of patients having a documented menstrual or sexual history.

authors

Stowers PN,Teelin KL

doi

10.1016/j.jpag.2019.05.007

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

520-524

issue

5

eissn

1083-3188

issn

1873-4332

pii

S1083-3188(19)30203-7

journal_volume

32

pub_type

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