Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Department of Emergency Medicine, Spectrum Health, Grand Rapids, Michigan.
J Emerg Med. 2022 Feb;62(2):200-206. doi: 10.1016/j.jemermed.2021.07.064. Epub 2021 Sep 17.
Hemorrhage from ruptured ectopic pregnancy is the leading cause of first trimester mortality in North America.
Our objective was to compare patients with a ruptured ectopic pregnancy who had an emergency department (ED) point-of-care ultrasound (PoCUS) with those who received a radiology department-performed ultrasound (RADUS). Four time intervals were measured: ED arrival to ultrasound interpretation, obstetric consultation, operating room (OR) arrival, and ultrasound interpretation to OR arrival.
This was a retrospective cohort study of patients with ruptured ectopic pregnancy seen between February 2012 and September 2018 at an urban tertiary care hospital. Patients who received an ultrasound in the ED, went directly to the OR, and had confirmed rupture were included.
Of 262 patients diagnosed with ectopic pregnancy during the study period, 36 (14%) were ruptured and 32 were enrolled. Comparing times between PoCUS (n = 10) and RADUS (n = 22) groups, the mean time from ED arrival to ultrasound interpretation was 15 vs. 138 min (difference 123, 95% confidence interval [CI] 88-158), from ED arrival to obstetric consultation was 35 vs. 150 min (difference 115, 95% CI 59-171), from ED arrival to OR arrival was 160 vs. 381 min (difference 222, 95% CI 124-320), and from ultrasound interpretation to OR arrival was 145 vs. 243 min (difference 98, 95% CI 12-184).
ED patients with a ruptured ectopic pregnancy who received a PoCUS first had shorter times to diagnosis, obstetric consultation, and OR arrival compared with those who received RADUS.
北美地区，输卵管妊娠破裂导致的出血是孕早期产妇死亡的首要原因。
本研究旨在比较在急诊科（ED）行即时超声检查（PoCUS）与在放射科行超声检查（RADUS）的输卵管妊娠破裂患者的各项指标。测量了四个时间间隔：ED 到达至超声解读、妇产科会诊、手术室（OR）到达以及超声解读至 OR 到达的时间。
这是一项回顾性队列研究，研究对象为 2012 年 2 月至 2018 年 9 月在一家城市三级保健医院就诊的输卵管妊娠破裂患者。研究纳入了 ED 行超声检查、直接进入 OR 且确诊为破裂的患者。
在研究期间，共诊断出 262 例输卵管妊娠患者，其中 36 例（14%）为破裂型，32 例纳入研究。比较 PoCUS（n=10）和 RADUS（n=22）组之间的时间，ED 到达至超声解读的平均时间分别为 15 分钟和 138 分钟（差值 123，95%置信区间[CI]88-158），ED 到达至妇产科会诊的平均时间分别为 35 分钟和 150 分钟（差值 115，95% CI 59-171），ED 到达至 OR 到达的平均时间分别为 160 分钟和 381 分钟（差值 222，95% CI 124-320），超声解读至 OR 到达的平均时间分别为 145 分钟和 243 分钟（差值 98，95% CI 12-184）。
与 RADUS 相比，在 ED 行 PoCUS 检查的输卵管妊娠破裂患者，在确诊、妇产科会诊和 OR 到达方面的时间更短。
