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Pelvic ultrasound is frequently performed in the ED in non-pregnant women to assess for ovarian pathology, though its use has not been described in the medical literature. This observational study aims to describe its use in clinical ED practice.
Pelvic ultrasound is frequently performed in the ED in non-pregnant women to assess for ovarian pathology. During the pelvic examination a transvaginal ultrasound probe is used to visualize ovarian size, determine echotexture, assess whether ovarian tenderness is present, and sometimes measure ovarian blood flow. Though pelvic ultrasound is used in the Hennepin County Medical Center ED routinely, there is a paucity of literature assessing it's utility.
This observational study will help determine the usefulness of this imaging modality, and how often it changes management in clinical practice.
Specifically, this study will attempt to determine how often transvaginal ultrasound identifies the structures of interest, and then will correlate these findings with the final ED diagnosis. If a formal ultrasound is obtained, the findings of the ED ultrasound will also be compared to the findings of the formal ultrasound.
The treating physicians will be queried the diagnosis and management plans before and after the pelvic US to ascertain changes in management.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cohort 1 | All women who undergo pelvic US in the ED, assuming they meet inclusion/exclusion criteria |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Pelvic US | Other | To be eligible for inclusion, a woman will have pelvic US completed as part of her ED stay. This is a non-interventional study. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in diagnosis before/after pelvic US | The treating physician will be queried the likelihood of EMERGENT and NON-EMERGENT ovarian pathology before and after pelvic US using the following scale: Definite, Probable, Possible, Very Unlikely. The ED tests reviewed before each of these judgements will be noted. EMERGENT is defined as ovarian torsion or tubo-ovarian abscess (TOA). NON-EMERGENT is defined as all other causes, including ovarian cyst, ovarian mass, ovarian malignancy, adnexal mass). The clinician will also free text the most likely diagnosis. A change of two or more levels (eg definite to possible, definite to very unlikely, probable to very unlikely, or vice versa) will be assumed to be a significant change in diagnosis. | 8 hours (or less, this will measure what occurs during an ED stay) |
| Change in management plan before/after pelvic US | The treating physician will choose from the following regarding the management plan before/after the pelvic US: outpatient referral to OB/GYN, formal pelvic US after bedside US, consult GYN in the ED, urgent/emergent operative intervention, None of the above. Any difference in management before/after pelvic US will be considered a significant change in management. | 8 hours (or less, this will measure what occurs during an ED stay) |
| Measure | Description | Time Frame |
|---|---|---|
| Sonographic visualization of ovaries | yes/no | 8 hours (or less, this will measure what occurs during an ED stay) |
| Duration of pelvic US | Less than 5 minutes, 5-10 minutes, more than 10 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Method of finding ovaries | Will choose from:
| 8 hours (or less, this will measure what occurs during an ED stay) |
| Experience of sonographer |
Inclusion Criteria:
Exclusion Criteria:
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Adult women for whom bedside transvaginal US is planned by their treating physician will be assessed for eligibility.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hennepin County Medical Center | Minneapolis | Minnesota | 55415 | United States |
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| ID | Term |
|---|---|
| D015746 | Abdominal Pain |
| D017699 | Pelvic Pain |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| 8 hours (or less, this will measure what occurs during an ED stay) |
| Ovary enlargement | Were the ovaries larger than 3.5 x 2 cm in any plane? yes/no answer | 8 hours (or less, this will measure what occurs during an ED stay) |
| Ovarian tenderness, sonographic | As a dichotomous yes/no. This will be correlated to final diagnosis. How many women with a non-tender ovary ended up with EMERGENT pathology? How many had NON-EMERGENT pathology? | 8 hours (or less, this will measure what occurs during an ED stay) |
| Ovarian blood flow | The physician will determine if the ovarian flow is normal in a dichotomous yes/no answer. (if performed) | 8 hours (or less, this will measure what occurs during an ED stay) |
| ED disposition after visit | This will measure if the patient is discharged from the ED or admitted to the hospital | 8 hours (or less, this will measure what occurs during an ED stay) |
| Final ED diagnosis | Two questions will be answered:
Question 2: Final ED diagnosis after all work-up: (select all that apply) checkbox
| 8 hours (or less, this will measure what occurs during an ED stay) |
| 7-day follow-up | Whether another facility was visited, whether a procedure occurred, and what else happened during this stay. Patients will be attempted to be contacted three times. | 7 days |
| Correlation between ED US and Formal US | If a formal US is obtained, the reading will be abstracted and compared to the ED US for the following: ovary visualization, ovary size, ovarian flow, final diagnosis, and any other abnormality in free text. | 8 hours (or less, this will measure what occurs during an ED stay) |
| Final impression for ED ultrasound with regards to ovaries | NORMAL or ABNORMAL. If abnormal, the abnormality will be described. | 8 hours (or less, this will measure what occurs during an ED stay) |
| Formal pelvic US | Was this study obtained? dichotomous yes/no. And why was a formal pelvic US obtained? (abnormality of ovaries on bedside US; other abnormality on bedside US; unable to visualize ovaries on bedside US; good visualization of all structures and all structures normal, but post-test probability still high; Other (free text). )The exact reason will then be listed in free text. | 8 hours (or less, this will measure what occurs during an ED stay) |
Choose from:
| 8 hours (or less, this will measure what occurs during an ED stay) |
| Pelvic physical exam characteristics | Was there tenderness on the exam (right/left adnexa, suprapubic region, no tenderness)? Were any masses felt? (right/left adnexa, suprapubic, no mass) | 8 hours (or less, this will measure what occurs during an ED stay) |
| D012817 | Signs and Symptoms, Digestive |