[The usefulness of emergency room data for integrated surveillance of spontaneous abortion at population level]

Objectives: to quantify and identify the proportion of miscarriages in the province of Trento (Trentino-Alto Adige Region, Northern Italy) in 2010-2016, managed exclusively at the emergency room (ER). Design: population surveillance study. Setting and participants: comparison between the Trentino computerized database of registration to the ER for miscarriage and the flow D-11 of the Italian National Statistics Institute (Istat) on hospitalized miscarriages in the period 2010-2016. Main outcome measures: for each year, the proportion of women seen at the ER for miscarriage and then hospitalized and the cases exclusively managed in ER were calculated. The two groups were compared on the basis of the following variables: age, citizenship, gestational week, calendar year, and ER of admission. Results: the proportion of miscarriages managed exclusively in ER in the province of Trento varies from 31.3% in 2010 to 60.5% in 2016. There are no differences in the proportion of hospitalization in relation to the age of women, while a higher proportion of hospitalizations was observed among foreign women compared to the Italians and in the ER of Trento compared to the peripheral ERs. A growing trend of hospitalization clearly appears with increasing gestational age, while the calendar year is inversely proportional to the increase in hospitalization. Conclusions: since the therapeutic diagnostic path of women with miscarriage has changed, it could be useful to have a representation as close as possible to the reality of the phenomenon to evaluate if an integration of the Istat D-11 flow on the cases hospitalized with those cases managed exclusively in ER is feasible or opportune. This opportunity should be considered in local, multicentre or national epidemiological studies.