Transvaginal Pelvic Ultrasound in the ED

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.

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.

yes/no

Less than 5 minutes, 5-10 minutes, more than 10 minutes

Were the ovaries larger than 3.5 x 2 cm in any plane? yes/no answer

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?

The physician will determine if the ovarian flow is normal in a dichotomous yes/no answer. (if performed)

This will measure if the patient is discharged from the ED or admitted to the hospital

Two questions will be answered:

• Ovarian Pathology, Emergency (tubo-ovarian abscess, torsion)
• Ovarian Pathology, Non-Emergency (cyst, mass, malignancy)
• Non-ovarian problem

Question 2:

Final ED diagnosis after all work-up: (select all that apply) checkbox

• ed_final_dx_2___1 ovarian cyst
• ed_final_dx_2___2 ovarian mass
• ed_final_dx_2___3 ovarian torsion
• ed_final_dx_2___4 tubo-ovarian abscess
• ed_final_dx_2___5 other ovarian pathology
• ed_final_dx_2___6 adnexal mass (non-ovarian)
• ed_final_dx_2___7 Pelvic Inflammatory Disease
• ed_final_dx_2___8 Abdominal pathology (appendicitis, diverticulitis, SBO, others)
• ed_final_dx_2___9 Non-specific abdominal pain
• ed_final_dx_2___10 None of the above and no ovarian pathology suspected

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.

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.

NORMAL or ABNORMAL. If abnormal, the abnormality will be described.

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.

Will choose from:

• Adjacent to pelvic vessels
• Followed out from uterine cornu
• No particular method used

Choose from:

• G1
• G2
• G3-G5
• Physician Assistant (PA)
• Attending
• US tech

Was there tenderness on the exam (right/left adnexa, suprapubic region, no tenderness)? Were any masses felt? (right/left adnexa, suprapubic, no mass)