The Impact of Tablet-Based Screening on Trichomonas Testing in the Pediatric Emergency Department

Objectives: Sexually transmitted infections (STIs) are a public health concern for adolescents and young adults, with half of STIs diagnosed annually among 15 to 24-year-olds. Trichomonas vaginalis is a high-prevalence STI, linked with increased risk for HIV and premature births. Methods: This was a planned, secondary analysis of a prospective pragmatic clinical effectiveness trial comparing targeted to universally-offered Neisseria gonorrhea and Chlamydia trachomatis (GC/CT) screening. Patients aged 15 to 21 years old across 6 pediatric emergency departments (PEDs) completed tablet-based sexual health surveys. In the universally offered phase, clinician decision support (CDS) fired if participants requested GC/CT testing. In the targeted phase, sexual health risks were stratified and providers were notified of at-risk and high-risk scores. Subsequent testing was per provider discretion. We compared Trichomonas testing rates and used multivariable logistic regression to test for effects of interest. Results: There were 98,413 patients seen across 6 sites; 4191 patients (4.3%) were tested for Trichomonas, with 219 testing positive (5.2%). Patients with CDS firing had 8.1 (aOR, 95% CI: 7.2-9.2) times higher odds of being tested for Trichomonas. Those triggering CDS in the universally-offered phase had 2.4 times higher odds of being tested (aOR, 95% CI: 1.8-3.3) compared with those during the targeted phase. In the targeted testing phase, high-risk patients had higher odds of testing, compared with low-risk patients (aOR: 22.1, 95% CI: 13.9-37.4). Conclusion: CDS alerts for GC/CT testing were associated with higher Trichomonas testing rates. Using an integrated CDS screening tool may increase Trichomonas testing in the PED and should be expanded to identify these infections.