Document Detail


Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis.
MedLine Citation:
PMID:  20828874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: Ectopic pregnancy is a common concern in emergency departments (EDs) and remains the leading cause of first-trimester mortality. Pelvic ultrasonography by emergency physicians has been investigated as a diagnostic test for ectopic pregnancy. We present a meta-analysis of the use of emergency physician ultrasonography in the evaluation of patients at risk of ectopic pregnancy.
METHODS: A structured search was performed of both MEDLINE and EMBASE. Inclusion criteria were that (1) the study reported original research on ED patients at risk for ectopic pregnancy; (2) an emergency physician performed and interpreted the initial pelvic ultrasonography; and (3) follow-up was conducted on all patients. Sensitivity was defined as the proportion of patients with ectopic pregnancy for which ED ultrasonography demonstrated no intrauterine pregnancy. A random-effects model was used to obtain summary test characteristics.
RESULTS: The initial search showed 576 publications, abstract review yielded 60 with potential relevance, and 10 studies were included. There was a total of 2,057 patients, of whom 152 (7.5%) had ectopic pregnancy. The pooled sensitivity estimate was 99.3% (95% confidence interval [CI] 96.6% to 100%), negative predictive value was 99.96% (95% CI 99.6% to 100%), and negative likelihood ratio was 0.08 (95% CI 0.025 to 0.25), all without significant heterogeneity.
CONCLUSION: The results of this meta-analysis suggest that in a wide variety of clinical settings, the use of bedside ultrasonography performed by emergency physicians as a diagnostic test for ectopic pregnancy provides excellent sensitivity and negative predictive value. Visualization of an intrauterine pregnancy by an emergency physician is generally sufficient to rule out ectopic pregnancy.
Authors:
John C Stein; Ralph Wang; Naomi Adler; John Boscardin; Vanessa L Jacoby; Gloria Won; Ruth Goldstein; Michael A Kohn
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.     Date:  2010-09-15
Journal Detail:
Title:  Annals of emergency medicine     Volume:  56     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-29     Completed Date:  2010-12-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  674-83     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Emergency Medicine, University of California, San Francisco, CA 94143, USA. jstein@medicine.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Confidence Intervals
Emergency Service, Hospital
Female
Humans
Point-of-Care Systems / standards,  statistics & numerical data
Pregnancy
Pregnancy, Ectopic / ultrasonography*
ROC Curve
Risk Factors
Sensitivity and Specificity
Grant Support
ID/Acronym/Agency:
1K08HS015569/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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