Diagnostic accuracy and clinical utility of emergency department targeted ultrasonography in the evaluation of first-trimester pelvic pain and bleeding: a systematic review.
OBJECTIVE
Emergency department targeted ultrasonography (EDTU) offers the possibility of rapid exclusion of ectopic pregnancy in patients with first-trimester pelvic pain or bleeding. We sought to systematically review the evidence describing the diagnostic accuracy and clinical utility of EDTU in the first trimester of pregnancy, and to generate a pooled estimate of the sensitivity and specificity of EDTU for the detection of intrauterine pregnancy (IUP).


METHODS
The literature search, abstract review and study selection were performed using predefined criteria. We abstracted the sensitivity and specificity of EDTU for IUP from included studies, and evaluated and summarized the evidence assessing the effect of EDTU use on time to diagnosis, time to treatment of ectopic pregnancy, emergency department (ED) length of stay and health care costs.


RESULTS
The specificity of EDTU for IUP in most studies exceeds 98%. The sensitivity in most studies exceeds 90%. Pooled estimates were not calculated because of statistical heterogeneity between studies. Published evidence indicates that EDTU use reduces the frequency of missed ectopic pregnancies, decreases time to surgery for ectopic pregnancy, shortens the length of stay for patients with normal pregnancies and may be more cost-effective than diagnostic strategies requiring formal ultrasonography.


CONCLUSIONS
EDTU is highly specific for the identification of IUP. Patients who have an IUP identified with EDTU may be safely discharged from the ED with outpatient follow-up. The specificity of EDTU for IUP, along with the potential improvements in patient care that EDTU affords, justifies its adoption as routine ED care in evaluating first-trimester pain or bleeding.
McRae
Andrew
A
Division of Emergency Medicine, University of Western Ontario, London, Ont. andrew.mcrae@lhsc.on.ca
Murray
Heather
H
Edmonds
Marcia
M
D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D009864:Ontario; D017699:Pelvic Pain / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011261:Pregnancy Trimester, First; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal / Q000592:standards* / Q000706:statistics & numerical data*; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging*