title: Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology.
abstract: OBJECTIVE
  Acute pelvic pain is a common reason for emergency room visits that can indicate a potentially life-threatening emergency (PLTE). Our objective here was to develop a triage process for PLTE based on a self-assessment questionnaire for gynecologic emergencies (SAQ-GE) in patients experiencing acute pelvic pain.
  
  
  METHODS
  In this multicenter prospective observational study, all gynecological emergency room patients seen for acute pelvic pain between September 2006 and April 2008 completed the SAQ-GE after receiving appropriate analgesics. Diagnostic procedures were ordered without knowledge of questionnaire replies. Laparoscopy was the reference standard for diagnosing PLTE; other diagnoses were based on algorithms. In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation.
  
  
  RESULTS
  Of 344 derivation-set patients and 172 validation-set patients, 96 and 49 had PLTEs, respectively. Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation. Sensitivity of the decision tree based on these three features was 87.5% (95% confidence interval (95% CI), 81%-94%) in the derivation set and 83.7% in the validation set. Derivation of the decision tree provided probabilities of PLTE of 13% (95% CI, 6%-19%) in the low-risk group, 27% (95% CI, 20%-33%) in the intermediate-risk group and 62% (95% CI, 48%-76%) in the high-risk group, ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%). In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%.
  
  
  CONCLUSIONS
  A simple triage model based on a standardized questionnaire may assist in the early identification of patients with PLTEs among patients seen in the gynecology emergency room for acute pelvic pain.
authors.affiliation: Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France ; UMR 216, IRD Paris Descartes, 4 Avenue de l'Observatoire, Paris - Université, 75 006 Paris Descartes, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dumont
authors.affiliation: INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Cochin, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Chantry
authors.affiliation: INSERM UMR S669, Université Paris Sud, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.affiliation: Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fauconnier
keywords: Gynecologic emergencies; Questionnaire; Sensitivity; Triage