An evaluation of clinical variables in determining the need for pelvic examination in the emergency department.
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.
Levitt
M A
MA
Division of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
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