Conribution of goal directed transvaginal ultrasonography to clinical decision making for emergency physicians in acute pelvic pain

The aim of this study was to determine contribution of ?goal-directed transvaginal ultrasonography? (TVUSG) on real-time clinical decision making of attending emergency physicians (AEP) evaluating their level of certainty for preliminary diagnosis, admission, surgery, treatment additional laboratory and discharge in patients presenting with acute pelvic pain to emergency department (ED). This prospective cross-sectional clinical study was conducted on sexually-active female patients over 18 years old complaining of acute pelvic pain in the ED of an urban tertiary care university hospital, with annual census of 90.000 adult ED patients, between July and December of 2011. The level of certainty of clinical decisions making as mentioned above were performed by visual analogue scale from 0 mm to 100 mm with 100 mm being most certain before and after TVUSG. Primary outcome measure of the study were to determine contribution of ?goal-directed TVUSG on real-time clinical decision making of AEP evaluating their level of certainty for preliminary diagnosis admission, surgery, treatment additional laboratory and radiological investigations and discharge in patients presenting with acute pelvic pain to ED. Final statistical analysis was performed on 88 patients. The mean age was 31.7 ±8.3 with a median of 30. Among clinical decisions, there was a significant difference between pre-TVUSG and post TVUSG certainty of the decision to perform preliminary diagnoses derived from patient?s history and physical examination but not in the other outcomes (treatment, admission, surgery and discharge). (p=0.05). Of the patients included in the study, 11 (12.5%) were admitted to hospital, and 2 of them (2.3%) were operated on. The remaining 75 patients (85.2%) were discharged from the ED with recommendations, of the patients that had been discharged, 18 patients (20.5%) later consulted another physician and no further pathology could be discovered. In conclusion, US performed by AEP may affects the certainty of their decisions in patients presenting with acute pelvic pain. This effect statistically significantly on the decision to perform preliminary diagnosis