University of Virginia Health System, USA.
University of Virginia Health System, USA.
Am J Emerg Med. 2024 Jun;80:143-148. doi: 10.1016/j.ajem.2024.03.036. Epub 2024 Apr 8.
Transvaginal (TVUS) and transabdominal ultrasound (TAUS) are both utilized in the evaluation of early pregnancy patients. While many practitioners using point of care ultrasound (POCUS) will generally not pursue TVUS in cases where an intrauterine pregnancy (IUP) is visualized on TAUS, this may not be true in Radiology performed ultrasound.
To evaluate for differences in transvaginal ultrasound (TVUS) utilization between Radiology performed (RP) ultrasound and point of care ultrasound (POCUS) by Emergency Department (ED) physicians in early pregnancy patients. Secondarily, to assess length of stay (LOS) differences and the impact of specialized emergency ultrasound training on TVUS utilization.
This was a retrospective study at a single academic ED. Study population was all ED patients who underwent first trimester ultrasound during the one year period of March 1, 2021 to February 28, 2022. Variables evaluated were chief complaint, gestational age, LOS, TAUS and TVUS utilization, ultrasound findings, and ultrasound specialty training of the ED physician.
There were 133 cases of POCUS ultrasound and 254 cases of RP ultrasound. All cases had TAUS imaging performed. Median LOS for patients when POCUS was utilized was 207 min (IQR 151-294) and 258 min (IQR 208-328) for those only using RP ultrasound, p ≤ 0.001. In the POCUS cohort, 38% (95% CI 30%-46%) received TVUS, while 94% received TVUS in the RP cohort (95% CI 90%-96%), p ≤ 0.001. Patients seen by ED faculty with ultrasound specialty training had TVUS 53% of the time (95% CI 41%-65%), while those seen by other ED faculty had TVUS 79% (95% CI 74%-83%) of the time, p = 0.035.
POCUS in early pregnancy is associated with a significant reduction in TVUS usage. We suspect that POCUS users elect not to pursue TVUS after an IUP is identified on TAUS, while technicians perform protocol-based TVUS irrespective of TAUS findings. Patients seen by ultrasound trained ED physicians are less likely to receive TVUS.
经阴道超声（TVUS）和经腹部超声（TAUS）均用于评估早期妊娠患者。虽然许多使用即时超声（POCUS）的医生在 TAUS 上看到宫内妊娠（IUP）时一般不会进行 TVUS，但放射科进行的超声检查可能并非如此。
评估放射科进行（RP）超声检查与急诊医师进行的即时超声检查（POCUS）在早期妊娠患者中 TVUS 使用情况的差异。其次，评估住院时间（LOS）差异和专门的急诊超声培训对 TVUS 使用的影响。
这是一项单中心学术急诊科的回顾性研究。研究人群为 2021 年 3 月 1 日至 2022 年 2 月 28 日期间进行第一孕期超声检查的所有急诊科患者。评估的变量包括主要症状、孕龄、LOS、TAUS 和 TVUS 使用情况、超声结果以及急诊科医师的超声专业培训。
POCUS 超声检查有 133 例，RP 超声检查有 254 例。所有患者均行 TAUS 成像。当使用 POCUS 时，患者的平均 LOS 为 207 分钟（IQR 151-294），仅使用 RP 超声时为 258 分钟（IQR 208-328），p≤0.001。在 POCUS 组中，38%（95%CI 30%-46%）接受了 TVUS，而在 RP 组中 94%接受了 TVUS（95%CI 90%-96%），p≤0.001。接受具有超声专业培训的急诊科医师检查的患者 TVUS 使用率为 53%（95%CI 41%-65%），而接受其他急诊科医师检查的患者 TVUS 使用率为 79%（95%CI 74%-83%），p=0.035。
早期妊娠中的 POCUS 与 TVUS 使用显著减少相关。我们推测，POCUS 用户在 TAUS 上发现 IUP 后选择不进行 TVUS，而技术员则根据协议进行 TVUS，而不考虑 TAUS 结果。接受经过超声培训的急诊科医师检查的患者接受 TVUS 的可能性较低。
