Shih C H
Department of Emergency Medicine, Kaiser Permanente Medical Center, San Francisco, California, USA.
Ann Emerg Med. 1997 Mar;29(3):348-51; discussion 352. doi: 10.1016/s0196-0644(97)70346-9.
To evaluate the sensitivity and specificity of emergency physician-performed pelvic sonography (EPPPS) and its effect on length of stay (LOS) in the emergency department.
The study involved a prospective observational convenience sample of women in early pregnancy requiring ED pelvic ultrasound evaluation. Differences in LOS were analyzed with the use of the Mann-Whitney test, with EPPPS and consultation status as classification variables. Results were stratified by diagnosis to identify patient subsets in which EPPPS had the greatest impact. A multivariate model was used to determine the independent associations of EPPPS and consultation status with LOS.
Among 115 pregnant patients, those who underwent EPPPS had a decreased median LOS compared with those who received pelvic sonography administered by radiologists or obstetrics-gynecology consultants (60 versus 180 minutes; P < .001). Obstetrics-gynecology consultation was associated with an increase in LOS from 60 to 170 minutes (P < .001). Stratification revealed that the decreased LOS was most significant in patients with viable intrauterine pregnancies (IUPs) and was not seen in those with abnormal pregnancies. This result was attributed primarily to the need for consultation in the latter group. Multivariate analysis demonstrated that EPPPS remained significantly associated with decreased LOS overall, after adjustment for the potentially confounding effect of consultation status (P < 001). The sensitivity of EPPPS for IUP was 94% (95% confidence interval [CI], 82% to 98%), and the specificity was 100% (95% CI, 83% to 100%). All 10 ectopic pregnancies, six of which were detected by EPPS and are included in the aforementioned sensitivity and specificity analysis, plus four detected by NEPPPS, were correctly identified; none was missed. No patient had an adverse outcome as a result of EPPPS.
Pelvic ultrasound performed by emergency physicians after a brief period of training shortens ED LOS in women in early pregnancy, particularly in those with viable IUPs. This practice appears to be sensitive, specific, and safe.
评估急诊科医生实施的盆腔超声检查（EPPPS）的敏感性和特异性及其对急诊科住院时间（LOS）的影响。
本研究纳入了需要进行急诊科盆腔超声评估的早孕女性的前瞻性观察便利样本。使用Mann-Whitney检验分析住院时间的差异，将EPPPS和会诊状态作为分类变量。结果按诊断分层，以确定EPPPS影响最大的患者亚组。使用多变量模型确定EPPPS和会诊状态与住院时间的独立关联。
在115名孕妇中，与接受放射科医生或妇产科会诊医生进行盆腔超声检查的患者相比，接受EPPPS检查的患者中位住院时间缩短（60分钟对180分钟；P <.001）。妇产科会诊与住院时间从60分钟增加到170分钟相关（P <.001）。分层显示，住院时间缩短在宫内活胎（IUP）患者中最为显著，而在异常妊娠患者中未观察到。这一结果主要归因于后一组患者需要会诊。多变量分析表明，在调整会诊状态的潜在混杂效应后，EPPPS总体上仍与住院时间缩短显著相关（P < 0.01）。EPPPS对IUP的敏感性为94%（95%置信区间[CI]，82%至98%），特异性为100%（95%CI，83%至100%）。所有10例异位妊娠均被正确识别，其中6例由急诊盆腔超声（EPPS）检测到并纳入上述敏感性和特异性分析，另外4例由非急诊盆腔超声（NEPPPS）检测到；无一漏诊。没有患者因EPPPS出现不良结局。
经过短暂培训后，急诊科医生进行的盆腔超声检查可缩短早孕女性的急诊科住院时间，尤其是宫内活胎患者。这种做法似乎具有敏感性、特异性和安全性。
