Diagnostic Evaluation for Abnormal Uterine Bleeding at Emergency Departments in the United States

We aimed to examine patterns of diagnostic evaluations for abnormal uterine bleeding (AUB) in a national sample of emergency department (ED) visits and identify potential racial and ethnic differences.

Using the 2014-2021 National Hospital Ambulatory Medical Care Survey data, we identified 1,049 (unweighted; 7,900,653 weighted) women age ≥18 years without previous cancer diagnosis who visited EDs for non-pregnancy-related AUB. The primary outcomes were whether an ultrasound was provided/ordered and whether referral/follow-up consultation was recommended. The association of race and ethnicity with these outcome measures was examined using multivariable logistic regressions adjusting for other patient/provider characteristics.

Multivariable regression analysis showed that non-Hispanic Black patients were less likely than non-Hispanic white patients to receive or have an ultrasound ordered (adjusted odds ratio [aOR] = .58, 95% confidence interval [CI] [.36, .92]). Non-Hispanic Black patients also had a lower likelihood of receiving referral or recommendation for follow-up consultation, compared with non-Hispanic white patients (aOR = .54, 95% CI [.31, .94]). Hispanic patients did not differ significantly from non-Hispanic white patients in these measures. Perimenopausal age (45-54 years) and location in a non-metropolitan area were associated with a lower likelihood of having an ultrasound performed/ordered or a referral/follow-up consultation recommended. Involvement of a consulting physician at the ED visit increased the likelihood of having an ultrasound performed/ordered while reducing the likelihood of referral/recommendation for follow-up consultation.

Among women presenting with AUB at EDs, diagnostic evaluation varied by race, suggesting a need to improve equity in care.