| Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. | |
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MedLine Citation:
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PMID: 20828874 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S. Date: 2010-09-15 |
Journal Detail:
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Title: Annals of emergency medicine Volume: 56 ISSN: 1097-6760 ISO Abbreviation: Ann Emerg Med Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-29 Completed Date: 2010-12-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 674-83 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Emergency Medicine, University of California, San Francisco, CA 94143, USA. jstein@medicine.ucsf.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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1K08HS015569/HS/AHRQ HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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