title: The impact of goal-directed transvaginal ultrasonography on clinical decision-making for emergency physicians.
abstract: The aim of study was to determine the impact of "goal-directed transvaginal ultrasonography" (TVUSG) on real-time clinical decision making of attending emergency physicians evaluating their level of certainty for preliminary diagnosis, admission, surgery, treatment, additional laboratory, and discharge in patients presenting with acute pelvic pain to the emergency department (ED). This prospective cross-sectional clinical study was conducted on sexually active female patients older than 18 years who presented with acute pelvic pain in the ED. The level of certainty of clinical decision making as mentioned above was measured by a visual analogue scale from 0 to 100 mm with 100 mm being most certain before and after TVUSG. Statistical analysis was performed on 88 patients. The mean age was 31.7 ±8.3 years with a median of 30 years. Among clinical decisions, there was a significant difference between pre-TVUSG and post-TVUSG certainty of the decision to perform preliminary diagnoses derived from patient's history and physical examination but not in the other outcomes (treatment, admission, surgery, and discharge). (P = .05). Of the patients included in the study, 11 (12.5%) were admitted to hospital, and 2 (2.3%) of them were operated on. The remaining 75 (85.2%) patients were discharged from the ED; of the patients that had been discharged, 18 (20.5%) patients later consulted another physician, and no further pathology could be discovered. In conclusion, US performed by attending emergency physicians may affect the certainty of their decisions in patients presenting with acute pelvic pain. This effect statistically significantly on the decision to determine preliminary diagnosis.
authors.affiliation: Antalya Research and Training Hospital Department of Emergency Medicine.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Sayrac
authors.affiliation: Akdeniz University Faculty of Medicine Department of Emergency Medicine. Electronic address: fbektas@akdeniz.edu.tr.
authors.forename: Firat
authors.initials: F
authors.lastname: Bektas
authors.affiliation: Akdeniz University Faculty of Medicine Department of Emergency Medicine.
authors.forename: Secgin
authors.initials: S
authors.lastname: Soyuncu
authors.affiliation: Antalya Research and Training Hospital Department of Emergency Medicine.
authors.forename: Vefa
authors.initials: V
authors.lastname: Sayrac
mesh_terms: D000038:Abscess / Q000150:complications / Q000000981:diagnostic imaging*; D059787:Acute Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D000328:Adult; D003430:Cross-Sectional Studies; D003657:Decision Making; D004635:Emergency Medicine; D005184:Fallopian Tube Diseases / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications / Q000000981:diagnostic imaging*; D006760:Hospitalization; D006801:Humans; D007889:Leiomyoma / Q000150:complications / Q000000981:diagnostic imaging; D010048:Ovarian Cysts / Q000150:complications / Q000000981:diagnostic imaging; D010049:Ovarian Diseases / Q000150:complications / Q000000981:diagnostic imaging; D034161:Pelvic Infection / Q000150:complications / Q000000981:diagnostic imaging*; D017699:Pelvic Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D055815:Young Adult