Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 1 Deaconess Rd, Rosenberg 2, Boston, MA 0215, USA.
Am J Emerg Med. 2019 Jun;37(6):1165-1168. doi: 10.1016/j.ajem.2019.03.025. Epub 2019 Mar 21.
Emergency physicians (EP) can accurately rule out ectopic pregnancy with pelvic point of care ultrasound (PPOCUS). Multiple studies have suggested that PPOCUS may decrease length of stay (LOS) for emergency department (ED) patients presenting with early symptomatic pregnancy compared to comprehensive ultrasound (CUS). This systematic review and meta-analysis examines the association between the use of PPOCUS vs CUS and ED LOS.
A systematic review of the literature was performed. Patients with symptomatic early pregnancy receiving EP-performed PPOCUS were compared to patients receiving CUS without PPOCUS. Keywords and search terms were generated for PPOCUS, ED LOS and CUS. Two independent reviewers screened abstracts for inclusion. A third reviewer was used when conflicts arose to gain consensus. Formal bias assessment was performed on included studies. Meta-analysis was carried out, pooling the mean differences between studies using a random-effects model.
2980 initial articles were screened, 32 articles underwent detailed review, 8 underwent bias assessment, and 6 were included in the final meta-analysis. There were 836 patients in the study group and 1514 in the control group. All studies showed a decreased LOS in the PPOCUS group with a mean decrease of 73.8 min (95% CI 49.1, 98.6). Two studies not included in the meta-analysis also showed significantly decreased LOS with PPOCUS.
Use of PPOCUS in the evaluation of patients with symptomatic early pregnancy is associated with decreased LOS in patients ultimately diagnosed with intrauterine pregnancy. This review suggests that this finding is generalizable to a variety of practice settings.
急诊医师（EP）可以通过盆腔床边即时超声（PPOCUS）准确排除宫外孕。多项研究表明，与全面超声（CUS）相比，PPOCUS 可减少因早期有症状妊娠而就诊于急诊科（ED）的患者的住院时间（LOS）。本系统评价和荟萃分析检查了使用 PPOCUS 与 CUS 与 ED LOS 之间的关联。
对文献进行了系统评价。将接受 EP 进行 PPOCUS 的有症状早期妊娠患者与未接受 PPOCUS 的接受 CUS 的患者进行比较。为 PPOCUS、ED LOS 和 CUS 生成了关键词和搜索词。两名独立的审查员筛选摘要以进行纳入。当出现分歧时，使用第三名审查员达成共识。对纳入的研究进行了正式的偏倚评估。使用随机效应模型对研究进行荟萃分析，合并研究之间的平均差异。
共筛选出 2980 篇初始文章，32 篇文章进行了详细审查，8 篇文章进行了偏倚评估，6 篇文章最终纳入荟萃分析。研究组有 836 例患者，对照组有 1514 例患者。所有研究均显示 PPOCUS 组的 LOS 降低，平均降低 73.8 分钟（95%CI 49.1，98.6）。两项未纳入荟萃分析的研究也显示 PPOCUS 可显著降低 LOS。
在有症状早期妊娠患者的评估中使用 PPOCUS 与最终诊断为宫内妊娠的患者的 LOS 降低相关。本综述表明，这一发现可推广到各种实践环境中。
