Association of Pregnancy Documentation with Radiological Imaging in the Emergency Department

Emergency department (ED) encounters are common for pregnant individuals in the United States. Radiological imaging is frequently ordered for diagnostics in the ED but generally avoided during pregnancy. This study examines missed pregnancy documentation and the association of pregnancy documentation with radiological imaging among individuals who have an ED encounter while pregnant.

We used a retrospective cohort of pregnant individuals who had a live birth in an urban county in Indiana 2022-2023. We pulled all ED encounters occurring between 42-279 days of gestation (N = 4,597) that did not occur within five days of delivery. Our primary outcome measure was pregnancy documentation in the patient's electronic health record and receipt of radiological imaging (radiograph and computed tomography) of the chest, abdomen or spine. We used descriptive statistics and logistic regressions for the analysis.

Pregnancy was not documented in 273 of the 4,597 encounters (5.9%). A larger percentage of encounters with missed pregnancy documentation occurred with non-Hispanic Black patients (162/273, 59.3%) compared to non-Hispanic White patients (75/273, 27.5%); (odds ratio 1.70, 95% CI, 1.21-2.41) for non-Hispanic Blacks relative to non-Hispanic Whites. Radiological imaging occurred in 147 of the 4,324 encounters with a documented pregnancy (3.4%), compared with 30 of the 273 encounters where the pregnancy was not documented (11.0%). Missed pregnancy documentation was associated with 2.11 times (95%CI, 1.30-3.42) the odds of receiving radiological imaging when adjusted for confounders.

Missed pregnancy documentation occurred in 5.9% of emergency encounters with pregnant patients. While this is uncommon, it is still significantly associated with receipt of radiological imaging. Disparities in odds of pregnancy documentation in the ED may contribute to differences in maternal outcomes and highlights the necessity of ensuring equitable care for all pregnant individuals.