Comprehensive Early Pregnancy Loss Management in the Emergency Department

Abstract

The goal of this study was to compare the outcomes of patients who present to the emergency department (ED) for early pregnancy loss (EPL) who receive comprehensive management in the ED versus referral for outpatient follow-up. We performed a retrospective cohort study of patients who presented to two EDs in our hospital system with EPL between 2014 and 2019. Patients received ED management (EDM; all counseling and/or management performed in ED) or outpatient management (OPM; discharged from ED and managed as an outpatient). We compared patients who received EDM and OPM on the proportion with complete EPL within one week, EPL-related complications, and time spent in the ED. We identified patients presenting to the ED with EPL using ICD-9 and 10 codes and abstracted relevant clinical information from their electronic health records. We tested for differences between EDM and OPM groups in the proportion with complete EPL within one week using multivariable logistic regression adjusted for age, race/ethnicity, insurance status, and specific EPL diagnosis to obtain odds ratios (ORs) and 95% confidence intervals (CIs). We identified 126 patients who received EDM and 37 who received OPM, and 78.6% and 54.1%, respectively, had complete EPL within one week. After adjustment, the odds of complete EPL within one week was 4.5 times higher among the EDM cohort than OPM (OR 4.55, 95%CI 1.78-11.67). The mean time spent in the ED was two hours longer among patients who received EDM (6.6 vs. 4.7 hours, p<0.001), but more patients who received OPM had EPL-related return ED visits (37.8% vs 11.9%, p<0.001). In conclusion, comprehensive EPL management has a positive impact on patient outcomes and on factors unique to the ED setting. Comprehensive care should be widely implemented to improve patient-centered care for patients seen in the ED with EPL.