title: An evaluation of clinical variables in determining the need for pelvic examination in the emergency department.
abstract: OBJECTIVE
  To evaluate the ability of multiple clinical variables to predict an increased or decreased probability of pelvic pathology, therefore determining when a pelvic examination is needed.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  An urban emergency department.
  
  
  METHODS
  246 female patients presenting with abdominal pain and undergoing pelvic examination.
  
  
  RESULTS
  The patients were divided into two groups. Group 1 consisted of 99 patients without pelvic pathology (40%) and group 2 consisted of 147 patients with pelvic pathology (60%). Pelvic pathology was defined as presence of infective discharge (with confirmation on wet mount/potassium hydroxide smear), presence of adnexal mass and/or tenderness, cervical motion tenderness, uterine enlargement and/or tenderness, blood in the vaginal vault, and culture report positive for Neisseria gonorrhea. The following variables achieved statistical significance (P less than .05) using a logistic regression model: history of vaginal discharge (odds ratio, 2.30 [95% confidence interval, 1.23 to 4.32]); history of dysmenorrhea/menorrhagia (4.35 [1.52 to 12.40]); right upper quadrant pain on physical examination (0.33 [0.13 to 0.85]); and left lower quadrant pain on physical examination or history (1.73 [0.94 to 3.19]).
  
  
  CONCLUSIONS
  History of vaginal discharge, history of dysmenorrhea/menorrhagia, and left lower quadrant pain on physical examination act as risk variables predicting presence of pelvic disease. Right upper quadrant pain on physical examination acts as a protective variable to predict absence of pelvic disease. This information may aid the emergency physician in determining the need for a pelvic examination in women with abdominal pain.
authors.affiliation: Division of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: M A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis*; D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004412:Dysmenorrhea / Q000150:complications; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008595:Menorrhagia / Q000150:complications; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D016017:Odds Ratio; D010388:Pelvis; D010808:Physical Examination; D012306:Risk; D014621:Vagina / Q000382:microbiology; D014626:Vaginal Smears