Impact of Overnight Formal Ultrasound on the Diagnosis of Ectopic Pregnancy (EP) Among Symptomatic Pregnancies of Unknown Location (PUL)

Abstract

Study Objective To assess changes in performance characteristics of the initial diagnoses established during a gynecologic consult for PUL after implementation of overnight formal ultrasound. Design This retrospective cohort study compares pre-intervention (2017) and post-intervention (2019) periods in a convenience sample. Setting Urban academic tertiary-care hospital, single institution. Patients or Participants Reproductive-aged women were included if they underwent a gynecologic consult for symptomatic PUL in the Emergency Department during after-hours (18:00-08:00). A total of 325 of 810 (40%) screened patients met inclusion criteria. For primary outcome analysis, 97 of 147 (66%) patients in 2017 and 111 of 178 (63%) patients in 2019 completed follow-up to final diagnosis. Interventions Overnight formal ultrasound was implemented Monday through Friday night in 2018 and was performed before or during a gynecologic consult. Measurements and Main Results Primary outcomes were gynecologic consult performance characteristics (eg- sensitivity, specificity, and predictive values). Quality measures relevant to early diagnosis of EP were also investigated. Descriptive statistics and significance were calculated using T-Test, Fisher's Exact, or Chi-square where appropriate (alpha=0.05). Fewer patients at the initial consult were discharged with a diagnosis of PUL, from 55% in 2017 to 30% in 2019, p=0.0002. Accurate initial diagnosis of EP increased from 52% to 76% of all EP, p=0.046. Positive predictive value for initial EP diagnosis improved from 79% to 97%, p=0.047. Populations were similar in baseline characteristics, admission for observation, and management of EP. Conclusion Overnight formal ultrasound increased accurate diagnosis of EP at the initial consult. Ongoing quality assessment should be considered for emergency gynecologic care.