OP06.02: Diagnostic values of clinical and ultrasound examination in women with acute pelvic pain

Abstract

To evaluate the value of clinical and ultrasound (US) examinations performed in the gynaecology emergency departement in women with acute pelvic pain. To assess the performance of clinical and US examination for diagnosing pathologies requiring immediate surgical management. Retrospective study of patients who underwent laparoscopy following emergency consultation for acute pelvic pain at the gynaecology emergency unit of a teaching hospital from January 2004 to December 31st 2006. Patients in whom physical and pelvic ultrasound examinations were performed were included and results were collected. Laparoscopy was considered justified if the final diagnosis was: hemoperotoneum > 300 ml, ruptured ectopic pregnancy, or active bleeding, or with a cardiac activity, pelvis inflammatory disease complicated of pelviperitonitis or pyosalpinx or tubo-ovarian abcess, adnexal torsion, appendicitis or occlusion. The sensitivities (Se), specificities (Spe), positive and negative likelihood ratio (LHR) were calculated for clinical and US examinations respectively. 231 patients had a laparoscopy following gynaecologic emergency consultation. In 136 cases, this emergency surgical treatment was needed. The Se, Spe, LHR+ and LHR− were 87.5%, 32.6%, 1.30 and 0.38 and 95.6%, 25.3%, 1.28 and 0.17 for clinical and US examinations alone respectively. When both clinical and US examinations were abnormal, there were 83.8%, 50.5%, 1.69 and 0.32 for Se, Spe, LLR+ and LLR− respectively. When only one of them was considered abnormal, there were 99.3%, 7.4%, 1.07 and 0.10 for Se, Spe, LLR+ and LLR− respectively. US examination may be used to select those patients who do not need an emergency surgical treatment and has better performance than clinical examination for that purpose. Clinical examination is not enough accurate to choose the best therapeutic decision.