Outcome Analysis of a Protocol Including Bedside Endovaginal Sonography in Patients at Risk for Ectopic Pregnancy☆,☆☆,★
Section snippets
INTRODUCTION
The accurate diagnosis of ectopic pregnancy (EP) is a considerable challenge for clinicians. Abbott et al1 demonstrated that emergency medicine residents and faculty miss this diagnosis during the initial emergency department visit in 43% of cases. Stovall et al2 reported that, before implementation of their ectopic screening program, 45% of patients with EP, who were evaluated primarily by residents in obstetrics and gynecology (Ob/Gyn) in an ED setting, had a delayed diagnosis, and 79% of EP
METHODS
The study was conducted during a 36-month period from May 1991 to May 1994. All females 18 years of age or older presenting to the ED were candidates for the study if they had a positive pregnancy test and also had, either alone or in combination, pelvic or abdominal pain, vaginal bleeding, orthostasis, adnexal mass or tenderness, or any risk factors for EP (ie, history of pelvic inflammatory disease, tubal ligation, abdominal or pelvic surgery, two or more elective abortions, infertility,
RESULTS
During the 3-year period, 314 patients were enrolled in the study. Of these, 14 patients were excluded from analysis because of incomplete data collection or follow-up. The initial EVS diagnoses (Table 1) included definite IUP, 169 (56%); probable abnormal IUP, 31 (10%); definite EP, 5 (2%); and no definite IUP, 95 (32%). Of the patients with no definite IUP on initial EVS, 28 (29%) were found to have an hCG concentration higher than 2,000 mIU/mL (IRP), and 67 (71%) had an hCG level lower than
DISCUSSION
In 1990, a publication of the Centers for Disease Control emphasized that "until risk factors that lead to ectopic pregnancy are established and controlled, early detection will be the most effective means of reducing morbidity and mortality associated with this condition." The important role of emergency physicians in the recognition of patients at risk for this disease was specifically identified.9 Rottem and Timor-Tritsch10 concluded that the "early diagnosis and treatment of ectopic
Acknowledgements
The authors wish to thank Michael Brown, MD, Steve Jameson, MD, and Steve Meldon, MD, who also participated as sonologists for the study, and Laura Zirzow for her assistance in manuscript preparation.
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From the Departments of Emergency Medicine* and Obstetrics and Gynecology‡, Medical College of Wisconsin, Milwaukee, Wisconsin; and Mt Sinai Hospital, Cleveland, Ohio.§
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Address for reprints: James R Mateer, MD, RDMS, Medical College of Wisconsin, Department of Emergency Medicine, 8700 West Wisconsin Avenue, Milwaukee, Wisconsin 53226, 414-257-5576, Fax 414-257-8040
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Reprint no. 47/1/69438