Point-of-care Ultrasound Diagnosis of a Ruptured Live Ectopic Pregnancy with Massive Hemoperitoneum

Adhikari, Srikar; Marx, Jared

doi:10.1016/j.jemermed.2012.05.008

Cited by 1 publication

(1 citation statement)

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“…With the introduction of ultrasound scans in the 1990’s, there has been little interest in studying clinical examination in the literature and recent well-designed studies evaluating the clinical examination in the context of gynecological emergencies are lacking [4]. This is likely explained by the limited additional diagnostic information provided by vaginal examination relative to that obtained by bedside emergency ultrasonography [31], as well as the potential hazards of this examination [16, 32] due to the lack of reproducibility and inter-observer variability.…”

Section: Discussionmentioning

confidence: 99%

Optimal Combination of Non-Invasive Tools for the Early Detection of Potentially Life-Threatening Emergencies in Gynecology

et al. 2016

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ObjectivesPotentially life-threatening gynecological emergencies (G-PLEs) are acute pelvic conditions that may spontaneously evolve into a life-threatening situation, or those for which there is a risk of sequelae or death in the absence of prompt diagnosis and treatment. The objective of this study was to identify the best combination of non-invasive diagnostic tools to ensure an accurate diagnosis and timely response when faced with G-PLEs for patients arriving with acute pelvic pain at the Gynecological Emergency Department (ED).MethodsThe data on non-invasive diagnostic tools were sourced from the records of patients presenting at the ED of two hospitals in the Parisian suburbs (France) with acute pelvic pain between September 2006 and April 2008. The medical history of the patients was obtained through a standardized questionnaire completed for a prospective observational study, and missing information was completed with data sourced from the medical forms. Diagnostic tool categories were predefined as a collection of signs or symptoms. We analyzed the association of each sign/symptom with G-PLEs using Pearson’s Chi-Square or Fischer’s exact tests. Symptoms and signs associated with G-PLEs (p-value < 0.20) were subjected to logistic regression to evaluate the diagnostic value of each of the predefined diagnostic tools and in various combinations.ResultsThe data of 365 patients with acute pelvic pain were analyzed, of whom 103 were confirmed to have a PLE. We analyzed five diagnostic tools by logistic regression: Triage Process, History-Taking, Physical Examination, Ultrasonography, and Biological Exams. The combination of History-Taking and Ultrasonography had a C-index of 0.83, the highest for a model combining two tools.ConclusionsThe use of a standardized self-assessment questionnaire for history-taking and focal ultrasound examination were found to be the most successful tool combination for the diagnosis of gynecological emergencies in a Gynecological ED. Additional tools, such as physical examination, do not add substantial diagnostic value.

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