Point of care ultrasound is associated with decreased ED length of stay for symptomatic early pregnancy

Published:March 20, 2019DOI:



      Emergency physicians (EP) can accurately rule out ectopic pregnancy with pelvic point of care ultrasound (PPOCUS). Multiple studies have suggested that PPOCUS may decrease length of stay (LOS) for emergency department (ED) patients presenting with early symptomatic pregnancy compared to comprehensive ultrasound (CUS). This systematic review and meta-analysis examines the association between the use of PPOCUS vs CUS and ED LOS.


      A systematic review of the literature was performed. Patients with symptomatic early pregnancy receiving EP-performed PPOCUS were compared to patients receiving CUS without PPOCUS. Keywords and search terms were generated for PPOCUS, ED LOS and CUS. Two independent reviewers screened abstracts for inclusion. A third reviewer was used when conflicts arose to gain consensus. Formal bias assessment was performed on included studies. Meta-analysis was carried out, pooling the mean differences between studies using a random-effects model.


      2980 initial articles were screened, 32 articles underwent detailed review, 8 underwent bias assessment, and 6 were included in the final meta-analysis. There were 836 patients in the study group and 1514 in the control group. All studies showed a decreased LOS in the PPOCUS group with a mean decrease of 73.8 min (95% CI 49.1, 98.6). Two studies not included in the meta-analysis also showed significantly decreased LOS with PPOCUS.


      Use of PPOCUS in the evaluation of patients with symptomatic early pregnancy is associated with decreased LOS in patients ultimately diagnosed with intrauterine pregnancy. This review suggests that this finding is generalizable to a variety of practice settings.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stein J.C.
        • Wang R.
        • Adler N.
        • et al.
        Obstetrics and gynecology/original research: emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis.
        Ann Emerg Med. 2010; 56: 674-683
        • McRae A.
        • Edmonds M.
        • Murray H.
        Diagnostic accuracy and clinical utility of emergency department targeted ultrasonography in the evaluation of first-trimester pelvic pain and bleeding: a systematic review.
        CJEM: Canadian Journal of Emergency Medicine. 2009; 11: 355
        • Bernstein S.L.
        • Aronsky D.
        • Duseja R.
        • et al.
        The effect of emergency department crowding on clinically oriented outcomes.
        Acad Emerg Med. 2009; 16: 1-10
        • Hoot N.R.
        • Aronsky D.
        Systematic review of emergency department crowding: causes, effects, and solutions.
        Ann Emerg Med. 2008; 52: 126-136
        • Chang A.M.
        • Lin A.
        • Fu R.
        • McConnell K.J.
        • Sun B.
        Associations of emergency department length of stay with publicly reported quality-of-care measures.
        Acad Emerg Med. 2017; 24: 246-250
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group P
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Sterne J.A.
        • Hernan M.A.
        • Reeves B.C.
        • et al.
        ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.
        BMJ (Clinical research ed). 2016; 355: i4919
        • SJ Higgins J.P.T.
        • Savović J.
        • Page M.J.
        • Hróbjartsson A.
        • Boutron I.
        • Reeves B.
        • et al.
        A revised tool for assessing risk of bias in randomized trials.
        Cochrane Database of Systematic Reviews. 2016; 10
        • Panebianco N.L.
        • Shofer F.
        • Fields J.M.
        • et al.
        Original contribution: the utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy.
        American Journal of Emergency Medicine. 2015; 33: 743-748
        • Shih C.H.
        Effect of emergency physician-performed pelvic sonography on length of stay in the emergency department.
        Ann Emerg Med. 1997; 29 ([discussion 352]): 348-351
        • Blaivas M.
        • Sierzenski P.
        • Plecque D.
        • Lambert M.
        Do emergency physicians save time when locating a live intrauterine pregnancy with bedside ultrasonography?.
        Acad Emerg Med. 2000; 7: 988-993
        • Thamburaj R.
        • Sivitz A.
        Does the use of bedside pelvic ultrasound decrease length of stay in the emergency department?.
        Pediatr Emerg Care. 2013; 29: 67-70
        • Chiem A.T.
        • Chan C.H.
        • Ibrahim D.Y.
        • et al.
        Pelvic ultrasonography and length of stay in the ED: an observational study.
        American Journal of Emergency Medicine. 2015; 32: 1464-1469
        • Burgher S.W.
        T, y TK, Dawdy MR. transvaginal ultrasonography by emergency physicians decreases patient time in the emergency department.
        Acad Emerg Med. 1998; 5: 802-807
        • Morgan B.B.
        • Kao A.
        • Trent S.A.
        • et al.
        Effect of emergency physician-performed point-of-care ultrasound and radiology department-performed ultrasound examinations on the emergency department length of stay among pregnant women at less than 20 weeks' gestation.
        J Ultrasound Med. 2018; 37: 2497-2505
        • Wilson S.P.
        • Connolly K.
        • Lahham S.
        • et al.
        Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay.
        World Journal of Emergency Medicine. 2016; 7: 178
        • Wang R.
        • Reynolds T.A.
        • West H.H.
        • et al.
        Use of a beta-hCG discriminatory zone with bedside pelvic ultrasonography.
        Ann Emerg Med. 2011; 58: 12-20
        • Tayal V.S.
        • Cohen H.
        • Norton H.J.
        Outcome of patients with an indeterminate emergency department first-trimester pelvic ultrasound to rule out ectopic pregnancy.
        Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2004; 11: 912-917
        • Mateer J.R.
        • Valley V.T.
        • Aiman E.J.
        • Phelan M.B.
        • Thoma M.E.
        • Kefer M.P.
        Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy.
        Ann Emerg Med. 1996; 27: 283-289