French S, Henry T, Williams E W
Emergency Medicine Division, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica.
West Indian Med J. 2014 Jun;63(3):247-51. doi: 10.7727/wimj.2013.230. Epub 2014 Jun 11.
Pregnant female patients with vaginal bleeding in the first trimester are seen commonly in the Emergency Department (ED) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. The protocol for the management of these patients requires that they have a sonographic evaluation performed for the purpose of localizing the pregnancy where possible, to assist with determining the risk for an ectopic pregnancy. The ultrasound examinations are performed in the radiology department.
This retrospective study was conducted to evaluate how long patients wait for a pelvic ultrasound. We also sought to establish how many patients had ultrasound findings that would have allowed safe discharge home.
The records of 150 patients seen in the six-month period from January 1 to July 30, 2008 were examined. Data were extracted pertaining to age, time to see an emergency room doctor, time taken for ultrasound examination to be obtained from the radiology department and the ultrasound findings.
Fifty-four per cent presented to the Emergency Department with a complaint of vaginal bleeding and abdominal pain, 29% with bleeding only, 16% with abdominal pain only and one with syncope. One hundred and sixteen of the patients enrolled had an ultrasound performed at UHWI. The average waiting time for an ultrasound was 3.8 ± 2.5 hours. The majority (66/116) of the patients had an intrauterine pregnancy (IUP) demonstrated on ultrasound. Twenty-nine had no IUP, free fluid or adnexal mass. These 95 patients would likely have been discharged home. Ten patients had an adnexal mass with or without free fluid, and ten had free fluid only on ultrasound. One patient was found to have a definite ectopic pregnancy. These 21 patients would have been referred for evaluation by the obstetrician on call for further management.
The majority of patients had sonographic findings that would have allowed safe and timely discharge from the Emergency Department had ultrasound been available at the point of care.
在牙买加金斯敦西印度大学医院（UHWI）急诊科，孕早期出现阴道出血的女性患者很常见。这些患者的管理方案要求尽可能对其进行超声评估，以确定妊娠位置，辅助判断异位妊娠风险。超声检查在放射科进行。
本回顾性研究旨在评估患者等待盆腔超声检查的时间。我们还试图确定有多少患者的超声检查结果允许其安全出院回家。
检查了2008年1月1日至7月30日这六个月期间150例患者的记录。提取了有关年龄、看急诊医生的时间、从放射科获得超声检查的时间以及超声检查结果的数据。
54%的患者因阴道出血和腹痛到急诊科就诊，29%仅因出血就诊，16%仅因腹痛就诊，1例因晕厥就诊。纳入研究的116例患者在UHWI进行了超声检查。超声检查的平均等待时间为3.8±2.5小时。大多数患者（66/116）超声显示为宫内妊娠（IUP）。29例患者超声未见IUP、无游离液体或附件包块。这95例患者可能已被允许出院回家。10例患者超声显示有附件包块，伴或不伴有游离液体，10例患者超声仅显示有游离液体。1例患者被确诊为异位妊娠。这21例患者将被转诊给随叫随到的产科医生进行进一步处理。
如果在护理点就能进行超声检查，大多数患者的超声检查结果本可允许其从急诊科安全、及时出院。
