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Emergency department visits and emergency-to-inpatient admissions for abnormal uterine bleeding in the USA nationwide
  1. Jessica Grubman1,2,
  2. Mitzi Hawkins1,
  3. Sara Whetstone1,
  4. Meg Autry1,
  5. Ann Lazar3,
  6. George F Sawaya1,
  7. Vanessa Jacoby1
  1. 1Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
  2. 2Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
  3. 3Department of Epidemiology and Biostatistics, Universitty of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Jessica Grubman, Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390, Texas, USA; jessica.grubman{at}utsouthwestern.edu

Abstract

Background Abnormal uterine bleeding (AUB) is a common but understudied gynaecological problem, and data are lacking on emergency department (ED) visits and associated ED-to-inpatient admissions for AUB. This project aims to further understanding of the burden of AUB on patients and the healthcare system by establishing the number and characteristics of women with AUB in the ED and evaluating predictors of AUB-related inpatient hospitalisation in the USA.

Methods This is a cross-sectional study of women presenting to the ED with non-malignant AUB in the 2016 US Nationwide Emergency Department Sample (NEDS). Clinical, demographic and hospital system factors were evaluated. χ2 and Mann-Whitney tests were used to compare the proportion of visits with each characteristic, resulting in inpatient admission versus discharge from the ED. Multivariable logistic regression models were used to analyse predictors of AUB in the ED and of AUB-related hospitalisations.

Results There were 1.03 million AUB-related visits in the 2016 NEDS, of which 11.2% resulted in inpatient admission. Clinical as well as demographic and hospital system factors influenced ED disposition. Women with AUB tended to be of reproductive age, be underinsured, live in lower income and urban areas, and present to urban and public hospitals. However, older age, higher income, better insurance, presentation to private hospitals and rural residence predicted inpatient admission.

Conclusions Our study highlights the ED as an essential place of care for women with AUB while also demonstrating the importance of access to outpatient gynaecology services as some AUB-related ED visits may be preventable with outpatient care. The significant demographic and hospital system differences, as well as expected clinical differences, between women with AUB admitted to inpatient and women discharged from the ED imply structural biases impacting AUB-related ED care and add to the deepening understanding of health disparities.

  • care systems
  • gynecology
  • utilisation
  • epidemiology
  • health service accessibility

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • Handling editor Ellen J Weber

  • Contributors There were no contributors outside of the authors of the manuscript. Primary study and data analysis planning, manuscript preparation and interpretation of data were done by the lead author, JG. Statistical analysis and data review were performed by AL, who also performed manuscript review. VJ critically reviewed the study protocol, assisted in developing the statistical analysis plan and data interpretation, and conducted manuscript review. GFS assisted in study planning, critically reviewed the study protocol and performed manuscript review. MA, MH and SW all contributed to manuscript review, critically revising it for important intellectual contact. All authors approved the final version of the manuscript to be published. The lead author, JG, is the guarantor of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.