ED endovaginal pelvic ultrasound in nonpregnant women with right lower quadrant pain.
BACKGROUND
We hypothesized that emergency physician-performed endovaginal ultrasound (EVUS) would change diagnostic decision making in nonpregnant women with right lower quadrant (RLQ) pain.


METHODS
A prospective cohort of female patients was enrolled at an urban emergency department (ED). Inclusion criteria were RLQ pain, hemodynamic stability, and a strong suspicion for appendicitis or right adnexal pathology. Treating physicians were queried regarding pre- and post-ED EVUS probability of disease, differential diagnoses, consultation, and management. Positive findings included large cysts or multitissue densities, tubal dilation, uterine enlargement/mass, and extensive peritoneal fluid.


RESULTS
With a positive ED EVUS, mean physician probability increased for gynecologic (24%) and decreased for both surgical (14%) and medical (20%) disease. With a negative ED EVUS, mean physician probability increased for surgical disease (5.3%) and decreased for gynecologic disease (18.6%).


CONCLUSIONS
Emergency department EVUS changes physician diagnostic decision making in nonpregnant women with undifferentiated RLQ pain.
Tayal
Vivek S
VS
Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA. vtayal@carolinas.org
Bullard
Mark
M
Swanson
Doug R
DR
Schulz
Christian J
CJ
Bacalis
Katrina N
KN
Bliss
Susan A
SA
Norton
H James
HJ
D015746:Abdominal Pain / Q000175:diagnosis*; D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000000981:diagnostic imaging*; D003657:Decision Making; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D005836:Genitalia, Female / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D010053:Ovary / Q000000981:diagnostic imaging; D011446:Prospective Studies; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging; D014621:Vagina / Q000000981:diagnostic imaging