Riese Alison, Tarr Elizabeth E, Baird Janette, Alverson Brian
Warren Alpert Medical School, Brown University, Providence, Rhode Island; and
Injury Prevention Center, Rhode Island Hospital, Providence, Rhode Island.
Hosp Pediatr. 2018 Apr;8(4):179-186. doi: 10.1542/hpeds.2017-0044.
To determine the frequency of sexual history taking and the associated characteristics of hospitalized adolescents in the pediatric hospitalist service.
A retrospective chart review of adolescents 14 to 18 years old who were admitted to the pediatric hospitalist service at an urban, academic children's hospital in the Northeast from 2013 to 2015 was conducted. Repeat admissions, admissions to specialty services, and charts that noted impairment because of psychosis, cognitive delay, or illness severity were excluded. For charts that met the criteria, the admission history and physical was carefully reviewed for a notation of sexual history. For those with documentation, sexual activity status and a risk level assessment were recorded. Patient demographics and admission characteristics were extracted. χ tests and logistic regression were used to examine differences between those with sexual history and those without.
A total of 752 charts met the criteria for inclusion. The majority of adolescents were girls ( = 506; 67.3%); the mean age was 15.7 years (SD = 1.2). Girls had 2.99 (95% confidence interval [CI] 2.18-4.11) higher odds of documentation than boys, and older adolescents had 1.41 (95% CI 1.03-1.91) higher odds than younger adolescents. Documentation did not differ significantly on the basis of admission type (medical or psychiatric), admission time, patient race and/or ethnicity, or provider gender. Among those with a documented sexual history, risk-level details were often omitted.
Sexual history taking does not occur universally for hospitalized adolescents. Girls were screened more often than boys despite similar rates of sexual activity. The inpatient admission may be a missed opportunity for harm-reduction counseling and adherence to sexually transmitted infection testing guidelines.
确定儿科住院医师服务中住院青少年性史询问的频率及相关特征。
对2013年至2015年在东北部一家城市学术儿童医院儿科住院医师服务部门收治的14至18岁青少年进行回顾性病历审查。排除重复入院、专科服务入院以及因精神病、认知延迟或疾病严重程度而注明有功能障碍的病历。对于符合标准的病历，仔细审查入院病史和体格检查以查看是否有性史记录。对于有记录的患者，记录其性活动状况和风险水平评估。提取患者人口统计学和入院特征。采用χ检验和逻辑回归分析有性史和无性史患者之间的差异。
共有752份病历符合纳入标准。大多数青少年为女孩（n = 506；67.3%）；平均年龄为15.7岁（标准差 = 1.2）。女孩有性史记录的几率比男孩高2.99倍（95%置信区间[CI] 2.18 - 4.11），年龄较大的青少年有性史记录的几率比年龄较小的青少年高1.41倍（95% CI 1.03 - 1.91）。有性史记录在入院类型（内科或精神科）、入院时间、患者种族和/或民族或医生性别方面无显著差异。在有性史记录的患者中，风险水平细节常常被遗漏。
并非所有住院青少年都会被询问性史。尽管性活动发生率相似，但女孩接受筛查的频率高于男孩。住院可能是减少伤害咨询和遵守性传播感染检测指南的一个被错过的机会。
