Performance of an Electronic Medical Record-based 'Syphilis Flag' in Identifying at-risk Patients in an Emergency Department.

ABSTRACT

BACKGROUND: The United States (US) has seen a > 40% increase in syphilis cases since 2017. Early disease identification and treatment are crucial. This review sought to identify emergency department (ED) patients at risk for syphilis. METHODS: A 30-day retrospective review was conducted of visits to a single ED. Patient visits were assessed for pre-determined syphilis 'flags' to include history of sexually transmitted infection (STI), current chief complaint (CC) or reason for visit (RFV) keyword(s) suggestive of potential STI, or positive pregnancy test. Flagged charts were assessed for STI testing results within six-months of ED visit. Data was analyzed using chi-square. RESULTS: There were 5537 total patient encounters, resulting in 455 flagged visits from 408 (8.4%) unique individuals, majority female (282, 69.1%; p < .001)), Black (251, 61.5%; p < .001), aged 15-44 (308, 75.5%; p < .001). Chief complaint was the most frequent flag (65.3%) followed by RFV (37.4%), prior STI (31.0%), and pregnancy (12.3%). Syphilis testing data was available for 120 flagged patents; 29 (24.2%) screened positive, including 11 (2.7% of total flagged cohort) with evidence for active infection. Among those, majority were Black (90.9%), male (72.7%), aged 25 to 34 (63.6%); nine (81.8%) had concomitant HIV; in active infection, prior STI flag was most common (72.7%), followed by CC (54.5%) and RFV (45.5%). CONCLUSION: This review demonstrates the performance of an EMR-based 'syphilis risk flag' screener applied to ED patients. Sex- and race-based discrepancies exist in flag rates, which may be reflective of sex- and race-based epidemiologic discrepancies in STI incidence.