Blackwell Sean C, Sullivan Erin M, Petrilla Allison A, Shen Xian, Troeger Kathleen A, Byrne James D
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Sciences Center, Houston, TX, USA.
Avalere Health, LLC, Health Economics and Outcomes Research, Washington, DC, USA.
Clinicoecon Outcomes Res. 2017 Oct 3;9:585-594. doi: 10.2147/CEOR.S141061. eCollection 2017.
To identify pregnant health plan members triaged through the emergency department (ED), including labor and delivery (ELD) units, with symptoms of preterm labor (PTL), and evaluate the use of fetal fibronectin (fFN) testing; and to calculate the rate of hospitalization and timing of delivery in relation to the ED visit.
Retrospective cohort study using Medical Outcomes Research for Effectiveness and Economics Registry, a national multipayer claims database. A cohort of pregnant women evaluated in an ELD with a diagnosis of PTL from June 2012 through November 2015 was identified. The proportion of women with PTL who received fFN testing was calculated.
A total of 23,062 patients met the criteria for inclusion in the study. The rate of fFN testing prior to delivery was 12.0%. Of the 23,062 patients included in the analysis, 75.9% were discharged home. Of those who were discharged from the emergency room, one in five went on to deliver within 3 days and almost 96% of this group was not screened for the presence of fFN. Of the remaining 24.1% of patients admitted to the hospital, 91.3% delivered during their stay. In a sensitivity analysis, the percentage of women who delivered within 3 days of the ELD encounter was lower for women who received fFN testing only (6.6%) versus those who had a history of transvaginal ultrasound (TVUS) only (21.6%). Furthermore, the rate of delivery within 3 days was lowest among patients who had both fFN testing and TVUS (4.7%).
The utilization of fFN testing is 12%. The majority of pregnant patients triaged through the ELD with symptomatic PTL do not receive an fFN test. As part of PTL evaluation, fFN testing may identify women at increased risk for preterm delivery and help determine appropriate patient management.
识别通过急诊科（ED）分诊的妊娠健康计划成员，包括分娩室（ELD），这些成员有早产（PTL）症状，并评估胎儿纤连蛋白（fFN）检测的使用情况；并计算与急诊就诊相关的住院率和分娩时间。
使用医疗结果研究有效性和经济学登记处（一个全国性的多支付方索赔数据库）进行回顾性队列研究。确定了一组在2012年6月至2015年11月期间在ELD接受评估且诊断为PTL的孕妇。计算接受fFN检测的PTL女性比例。
共有23062名患者符合纳入研究的标准。分娩前fFN检测率为12.0%。在纳入分析的23062名患者中，75.9%出院回家。在从急诊室出院的患者中，五分之一的人在3天内分娩，且该组中近96%未进行fFN检测。在其余24.1%入院的患者中，91.3%在住院期间分娩。在敏感性分析中，仅接受fFN检测的女性在ELD就诊后3天内分娩的百分比（6.6%）低于仅经阴道超声（TVUS）检查的女性（21.6%）。此外，同时进行fFN检测和TVUS检查的患者在3天内分娩的比例最低（4.7%）。
fFN检测的利用率为12%。大多数通过ELD分诊且有症状性PTL的孕妇未接受fFN检测。作为PTL评估的一部分，fFN检测可能识别出早产风险增加的女性，并有助于确定适当的患者管理方案。
