Perinatal & Pediatric
Characteristics of US Emergency Department Visits Related to Ectopic Pregnancies, 2019–2020 Lindsay S. Womack-Martenson* Lindsay Womack Elizabeth Clark Sabrina Karim Lisa Ashley Busacker Angela Rohan
Background: Ectopic pregnancy is the leading cause of pregnancy-related death due to hemorrhage. Many are diagnosed in emergency departments (EDs) with more severe cases resulting in inpatient admission. This study aimed to estimate the number of ED visits related to ectopic pregnancies in 2019–2020, examine factors associated with inpatient admission from the ED, and analyze surgical treatment among admitted cases.
Methods: Using 2019–2020 HCUP Nationwide Emergency Department Sample (NEDS) data, we analyzed ED visits related to ectopic pregnancies among females aged 15–44 years, identified using ICD-10-CM, ICD-10-PCS, and CPT codes. Data in the NEDS can be weighted to provide national estimates; these weights were used in this analysis. Logistic regression models with predicted marginals were used to quantify the association between inpatient admission and patient, community, and hospital characteristics. Among inpatient admissions, surgical treatment was classified using ICD-10-PCS codes.
Results: Of 103,102 ED visits related to ectopic pregnancies, 15.5% resulted in inpatient admission. Admission rates were higher for patients aged ≥35 years (adjusted prevalence ratio [APR] 1.64; 95% CI, 1.15–2.35), Hispanic (APR 1.31; 95% CI, 1.09–1.58) or non-Hispanic American Indian/Alaska Native patients (APR 2.35; 95% CI, 1.06 –5.21), Medicaid/Medicare patients (APR 1.17, 95% CI, 1.01-1.35), those in the lowest income quartile (APR 1.46; 95% CI, 1.14-1.88), and patients at level III trauma centers (i.e., lowest level) (APR 1.93; 95% CI, 1.33-2.80). Among 15,964 admissions, 22.9% underwent open surgery, 45.2% had minimally invasive surgery, and 31.8% received non-surgical treatment.
Conclusions: There are differences in inpatient admissions among ED visits for ectopic pregnancies by age, race, ethnicity, socioeconomic status, and facility type. Higher admission rates at level III trauma centers may indicate differences in resource availability or patient characteristics.