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Efficient Use of Early Obstetric Sonography in the Emergency Department Setting
Author(s) -
Goodman Linnea R.,
Eichelberger Kacey Y.,
Wolfe Honor,
Steiner Anne Z.
Publication year - 2012
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/jum.2012.31.12.1917
Subject(s) - medicine , emergency department , confidence interval , retrospective cohort study , obstetrics , odds ratio , expectant management , logistic regression , triage , cohort , hematocrit , pregnancy , gynecology , surgery , gestation , emergency medicine , psychiatry , biology , genetics
Objectives Transvaginal sonography is frequently used in the emergency department (ED) to triage pregnancies of unknown location. The purpose of this study was to examine the utility of sonography in clinically stable patients with β‐human chorionic gonadotropin (β‐hCG) values below the discriminatory zone. Methods We conducted a retrospective cohort study of 408 consecutive ED patients who presented with pregnancies of unknown location and serum β‐hCG levels between 5 and 2500 mIU/mL and underwent transvaginal sonography. Women were classified as receiving immediate treatment or expectant management. Predictors associated with immediate treatment were assessed by bivariate analyses and logistic regression. Results Of the cohort, 361 women (88.5%) received expectant management, and 6.9%, 3.1%, and 0% of patients with pregnancies of unknown location and β‐hCG levels below 1000, 200, and 75 mIU/mL, respectively, received immediate treatment. Compared to the expectant management group, women receiving immediate treatment (n=47) were further from the last menstrual period (7.86 versus 6.10 weeks; P <.01), were more likely to report pain (59.6% versus 40.2% P = .01), had higherβ‐hCG levels(1183 versus 608 mIU/mL; P <.01), and had lower hematocrit levels (35.7% versus37.0%; P < .01), with pain the most predictive factor for immediate treatment (odds ratio,5.97; 95% confidence interval, 2.45–14.53). A model combining symptoms, β‐hCG, hematocrit, and weeks since the last menstrual period predicted the likelihood of sonographychanging management from expectant management to immediate treatment with specificity of 98%. Conclusions The diagnostic utility of sonography in clinically stable patients presenting to the ED in very early pregnancy is limited. A model using symptoms, β‐hCG, hematocrit, and the last menstrual period may aid clinicians to triage those who would benefit from immediate sonography.