Emergency Department Utilization for Adnexal Torsion: An Analysis of the Nationwide Emergency Department Sample from 2006 to 2018.

Study Objective: To characterize emergency department (ED) utilization for adnexal torsion (AT) among adult patients in the United States.

Design: Retrospective analysis to identify primary AT diagnoses and ED utilization. Other variables analyzed included primary payer type, income quartile by ZIP code, hospital teaching status, and urban vs rural location. Secondary analyses identified diagnosis codes associated with a primary diagnosis of AT.

Setting: Healthcare Cost and Utilization Project Nationwide Emergency Sample database.

Patients: Women aged 18 to 65 years presenting to the ED with AT from 2006 to 2018.

Interventions: Not applicable.

Measurements And Main Results: From 2006 to 2018, the annual number of ED visits for AT among women aged 18 to 65 years increased from 2791 to 5243. Hospital admission rates for AT declined over the study period from 76% to 37%. Patients with AT were less likely to be admitted if they had private insurance, but admission rates for AT were similar regardless of income quartile and hospital teaching status. Average ED charges for AT nearly quadrupled over the study period compared with ED charges overall, which doubled. The average charge for AT patients in 2006 was $5212 and in 2018 was $20 213-an average annual increase of 24.0%, compared with 14.3% for all other diagnoses in age-matched women.

Conclusion: Although admission rates for AT decreased by 50% from 2006 to 2018, ED utilization nearly doubled, and the average associated charges quadrupled, summing to an annual weighted charge of over $500 million by 2018. The data suggest that women are evaluated similarly for AT regardless of income or insurance status.