Gonorrhea and Chlamydia Screening for Adolescents and Young Adults in Emergency Departments
Abstract
Importance: Adolescents account for almost half of the 2.5 million diagnosed sexually transmitted infections in the US annually, and the emergency department functions as the primary source of health care for many adolescents. No recommendations exist for emergency department gonorrhea and chlamydia screening.
Objective: To compare usual care against targeted and universally offered gonorrhea and chlamydia screening approaches.
Design, setting, and participants: This was a comparative effectiveness, multicenter, pragmatic trial with a type 3 hybrid stepped-wedge crossover design implemented over approximately 20 months at 6 pediatric emergency departments in the US. Patients aged 15 to 21 years presenting to the emergency department between January 2021 and September 2022 were included, excluding those who were unable to understand English, were critically ill, were with concern for sexual assault or abuse, had cognitive impairment or altered mental status, or were otherwise unable to provide consent. Of 98 413 emergency department presentations during the study period, 7503 adolescents underwent testing.
Interventions: Patients completed a computerized sexual health survey. During the universally offered screening intervention, gonorrhea and chlamydia screening was offered to all participants, and clinical decision support for testing was based solely on the patient's decision to undergo testing (survey results were not available to clinicians). During the targeted…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 7,503 participants or records.
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