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Diagnostic accuracy and clinical utility of emergency department targeted ultrasonography in the evaluation of first-trimester pelvic pain and bleeding: a systematic review

Published online by Cambridge University Press:  21 May 2015

Andrew McRae ,
Marcia Edmonds  and
Heather Murray
Andrew McRae*
Affiliation:
Division of Emergency Medicine, University of Western Ontario, London, Ont. Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ont.
Marcia Edmonds
Affiliation:
Division of Emergency Medicine, University of Western Ontario, London, Ont.
Heather Murray
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, Ont. Department of Community Health and Epidemiology, Queen's University, Kingston, Ont.
*
Department of Emergency Medicine, London Health Sciences Centre, 800 Commissioners Rd., London ON N6A 5W9; [email protected]

Abstract

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Objective:

Emergency department targeted ultrasonography (EDTU) offers the possibility of rapid exclusion of ectopic pregnancy in patients with first-trimester pelvic pain or bleeding. We sought to systematically review the evidence describing the diagnostic accuracy and clinical utility of EDTU in the first trimester of pregnancy, and to generate a pooled estimate of the sensitivity and specificity of EDTU for the detection of intrauterine pregnancy (IUP).

Methods:

The literature search, abstract review and study selection were performed using predefined criteria. We abstracted the sensitivity and specificity of EDTU for IUP from included studies, and evaluated and summarized the evidence assessing the effect of EDTU use on time to diagnosis, time to treatment of ectopic pregnancy, emergency department (ED) length of stay and health care costs.

Results:

The specificity of EDTU for IUP in most studies exceeds 98%. The sensitivity in most studies exceeds 90%. Pooled estimates were not calculated because of statistical heterogeneity between studies. Published evidence indicates that EDTU use reduces the frequency of missed ectopic pregnancies, decreases time to surgery for ectopic pregnancy, shortens the length of stay for patients with normal pregnancies and may be more cost-effective than diagnostic strategies requiring formal ultrasonography.

Conclusion:

EDTU is highly specific for the identification of IUP. Patients who have an IUP identified with EDTU may be safely discharged from the ED with outpatient follow-up. The specificity of EDTU for IUP, along with the potential improvements in patient care that EDTU affords, justifies its adoption as routine ED care in evaluating first-trimester pain or bleeding.

Keywords

ultrasoundultrasonographyectopic pregnancyspontaneous abortionemergency medicine
Type
State of the Art • Á la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 4 , July 2009 , pp. 355 - 364
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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