Pregnant adolescents in the emergency department: diagnosed and not diagnosed.

A study was conducted to compare the presenting complaints and historical information of adolescents diagnosed as pregnant (DP) in the emergency department (ED) with adolescents seen in the ED who were pregnant and not diagnosed (MP). Medical records for the period 1980-94 were retrospectively analyzed to identify patients 16 years of age or younger who were diagnosed as pregnant in the ED or who had a live birth and had an ED visit during pregnancy. This analysis was done in a university-affiliated tertiary referral hospital with approximately 65,000 ED visits and 3,500 deliveries each year. The DP patients had complaints referable to the abdomen or genitourinary system more commonly than the MP patients (91% v 22%). Less than 10% of the DP patients mentioned the possibility of pregnancy at initial triage, 10.5% denied being sexually active, and 5% had a pelvic examination and sexually transmitted disease screening; 68% of MP patients did not have sexual or menstrual history documented, and 5% had a pelvic examination. The diagnosis of pregnancy can be a challenge in patients who present to a busy ED with complaints that are not necessarily suggestive of pregnancy. Historical information regarding menses and sexual activity is either not obtained or is incomplete or inaccurate. We recommend a low threshold for the consideration of pregnancy in adolescents irrespective of the presenting complaint.

PIP: A retrospective study was performed at a tertiary care hospital in Mississippi to compare the emergency room (ER) presenting complaints during 1980-1994 of the 171 pregnant adolescents 16 years old and younger whose pregnancies were diagnosed with the 100 whose pregnancies were not diagnosed. Data were collected from the medical records of those diagnosed as pregnant and from the 2945 records available of the 4125 patients under 16 who delivered babies at the hospital during the same period. It was found that 100/2945 were seen in the ER while pregnant but the pregnancy was not diagnosed. It was found that 91% of the pregnancy diagnosed patients versus 22% of the missed diagnosis patients had complaints relating to the abdomen or genitourinary system. Less than 10% of the diagnosed patients indicated the possibility of pregnancy at the initial examination, and 10.5% denied being sexually active. No sexual or menstrual history was documented for 68% of the missed diagnosis patients, and 5% of each group had pelvic examinations. No significant differences were found for patient age or demographics, gestation at ER visit, or gestation at delivery. In 30 cases of missed diagnoses (all with gestation at 8 weeks or more), 23 presented with abdominal, genitourinary, or mammary complaints, and 7 presented with drug overdoses. In 22 patients, diagnosis was missed even though the pregnancy was at 22 weeks gestation or more. One extraordinary case involved a 14-year-old who was admitted for treatment of a gunshot to the head. Her pregnancy was not diagnosed until her second follow-up visit after a lengthy hospital stay (gestation was 30 weeks at ER presentation). Because many treatments are modified by pregnancy, it is recommended that pregnancy be assumed in all females of child-bearing age presenting to the ER with consideration given to degree of sexual maturity.

Screening out the doubts: educating patients and clinicians about mammography.

Despite extensive educational campaigns directed at both the public and clinicians, some primary care physicians still hesitate to refer patients for screening mammography. To increase referrals, radiologists need to understand the reasons for this hesitancy and the ways in which successful mammography centers have allayed clinicians' reservations.

Equipment focus: shielding systems for MRI installations.

This article takes a look at shielding products on the market. Included is a discussion of the difficulties involved in shielding a mobile magnetic resonance imaging system.

Facility report: mobile lithotripsy.

Four Virginia hospitals are banding together to bring mobile lithotripsy to their communities, using the excess capacity from a unit based in North Carolina.

Transport design considerations in mobile imaging trailers.

Executives from several mobile imaging companies discuss design considerations related to the "mobility" of MRI and other modalities: weight, vibration, ease of leveling and setup, shielding, and, for superconductive MRI units, helium boil-off and reliability of power supply.

Imaging center design and construction: good planning pays off.

The right planning at blueprint stage can mean extra income later on for imaging centers. Here, center operators discuss what they did right and wrong in planning the design and construction of their centers.

Imaging forecast: tools of the future.

What will be the tools of radiology in the years ahead? If the manufacturing and government experts consulted by APPLIED RADIOLOGY are right, exciting years lie ahead. New imaging techniques, display capacity--including three-dimensional holograms--and digital image networks all await in the future.

Los Robles Regional Medical Center, Department of Hyperbaric Medicine.

The hyperbaric medicine facility of this 220-bed acute-care hospital in Thousand Oaks, Calif, is the second largest of its kind in the state.