ED endovaginal pelvic ultrasound in nonpregnant women with right lower quadrant pain

Tayal, Vivek S.; Bullard, Mark; Swanson, Doug R.; Schulz, Christian J.; Bacalis, Katrina N.; Bliss, Susan A.; Norton, H. James

doi:10.1016/j.ajem.2007.02.029

« Previous Next »American Journal of Emergency Medicine
Volume 26, Issue 1 , Pages 81-85, January 2008

ED endovaginal pelvic ultrasound in nonpregnant women with right lower quadrant pain

Vivek S. Tayal, MD
- Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA
- Corresponding author. Tel.: +1 704 355 3181; fax: +1 704 355 7047.
Mark Bullard, MD
- Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA
Doug R. Swanson, MD
- Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA
Christian J. Schulz, PA
- Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA
Katrina N. Bacalis, PA
- Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA
Susan A. Bliss, MD
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC 28232, USA
H. James Norton, PhD
- Department of Biostatistics, Carolinas Medical Center, Charlotte, NC 28232, USA

Received 29 January 2007; received in revised form 9 February 2007; accepted 9 February 2007.

Abstract

Introduction

We hypothesized that emergency physician–performed endovaginal ultrasound (EVUS) would change diagnostic decision making in nonpregnant women with right lower quadrant (RLQ) pain.

Methods

A prospective cohort of female patients was enrolled at an urban emergency department (ED). Inclusion criteria were RLQ pain, hemodynamic stability, and a strong suspicion for appendicitis or right adnexal pathology. Treating physicians were queried regarding pre– and post–ED EVUS probability of disease, differential diagnoses, consultation, and management. Positive findings included large cysts or multitissue densities, tubal dilation, uterine enlargement/mass, and extensive peritoneal fluid.

Results

With a positive ED EVUS, mean physician probability increased for gynecologic (24%) and decreased for both surgical (14%) and medical (20%) disease. With a negative ED EVUS, mean physician probability increased for surgical disease (5.3%) and decreased for gynecologic disease (18.6%).