Emergency department visits for undiagnosed pelvic organ prolapse

Abstract

Objectives

To describe women presenting to the emergency department (ED) for previously undiagnosed pelvic organ prolapse (POP). Secondary objective was to determine rates of outpatient specialty follow-up and factors associated with accessing follow-up care.

Study design

Retrospective study of patients who presented at 3 EDs affiliated with an urban academic health system that received a new diagnosis of POP between January 2016 and September 2022. Data on demographics, chief complaint, evaluation and interventions performed in the ED, and follow-up care within 3 months post-ED discharge were abstracted from the medical chart. Descriptive statistics and bivariate analyses were used to compare characteristics of women who did and did not follow-up for specialty or subspecialty care.

Results

56 patients met inclusion criteria. Mean age was 61.2 ± 17.1 years. The majority identified as either non-Hispanic Black (51.8 %) or Hispanic or Latino (25.0 %). 57.1 % of patients had public insurance. Less than half (42.8 %) of patients underwent follow-up care with a urogynecologist or gynecologist within 3 months after ED discharge. Race was found to be significantly associated with follow-up rates (P = 0.03), with non-Hispanic Black women experiencing the lowest rates (20.7 %) of follow-up.

Conclusions

POP causes sufficient distress to prompt an ED encounter. A subset of women overrepresented by Black and publicly insured women utilize the ED for initial POP evaluation, when compared to patients who access initial outpatient POP care. A minority of patients underwent outpatient follow-up. Further research is needed to understand care-seeking behaviors for POP and barriers to timely outpatient follow-up care.