Patient Characteristics and Provider Practice Patterns for Emergency Contraception in a Pediatric Emergency Department

Abstract

To describe epidemiologic and clinical characteristics of patients receiving emergency contraception (EC) in a pediatric emergency department (ED), practice variations for EC, and ED return visits after EC. This single-site study describes all patients who received oral EC (1.5-mg levonorgestrel) in the ED from January 1, 2003 to December 31, 2007. A chart review provided patient demographics, history, examination findings, treatment, and ED return visits within 7 days. There were 116 patients with a mean age of 13.7 years; half were white, and most (69.8%) had Medicaid. The most common presenting complaint was nonconsensual sex or sexual assault (87.9%). Most patients (89.6%) reported last sexual contact within 72 hours of presentation. Half of the patients (50%) received 1.5-mg levonorgestrel in a single dose, and there was a significant trend toward single-dose distribution during the study (P < 0.001). Patient presentation was most common from 8 pm to midnight (P < 0.001). Most received a pregnancy test (98.3%), a pelvic bimanual or speculum examination (81.9%), and prophylactic or immediate treatment of a sexually transmitted infection (88.8%). No prescriptions for future EC were given. One patient returned to the ED 1 day after receiving EC complaining of nausea and blurry vision. Reviewing recipients of EC from a pediatric ED suggests education is needed for both health care providers and adolescents. Although providers are generally following the most recent dosing guidelines, opportunities to prescribe EC to adolescent girls with complaints other than sexual assault seem to be missed.