Point of care ultrasound is associated with decreased ED length of stay for symptomatic early pregnancy

• Published in: The American journal of emergency medicine Vol. 37; no. 6; pp. 1165 - 1168
• Main Authors: Beals, Tyler, Naraghi, Leily, Grossestreuer, Anne, Schafer, Jesse, Balk, Dan, Hoffmann, Beatrice
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019; Elsevier Limited
• Subjects: Bias; Ectopic pregnancy; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Length of stay; Length of Stay - statistics & numerical data; Literature reviews; Meta-analysis; Point of care ultrasound; Point-of-Care Systems; Pregnancy; Pregnancy complications; Pregnancy Complications - diagnostic imaging; Pregnancy Trimester, First; Pregnancy, Ectopic - diagnostic imaging; Randomized Controlled Trials as Topic; Studies; Systematic review; Ultrasonic imaging; Ultrasonography, Prenatal - methods; Ultrasound; Ectopic pregnancy; Point of care ultrasound; Length of stay
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.03.025

Emergency physicians (EP) can accurately rule out ectopic pregnancy with pelvic point of care ultrasound (PPOCUS). Multiple studies have suggested that PPOCUS may decrease length of stay (LOS) for emergency department (ED) patients presenting with early symptomatic pregnancy compared to comprehensive ultrasound (CUS). This systematic review and meta-analysis examines the association between the use of PPOCUS vs CUS and ED LOS.
A systematic review of the literature was performed. Patients with symptomatic early pregnancy receiving EP-performed PPOCUS were compared to patients receiving CUS without PPOCUS. Keywords and search terms were generated for PPOCUS, ED LOS and CUS. Two independent reviewers screened abstracts for inclusion. A third reviewer was used when conflicts arose to gain consensus. Formal bias assessment was performed on included studies. Meta-analysis was carried out, pooling the mean differences between studies using a random-effects model.
2980 initial articles were screened, 32 articles underwent detailed review, 8 underwent bias assessment, and 6 were included in the final meta-analysis. There were 836 patients in the study group and 1514 in the control group. All studies showed a decreased LOS in the PPOCUS group with a mean decrease of 73.8 min (95% CI 49.1, 98.6). Two studies not included in the meta-analysis also showed significantly decreased LOS with PPOCUS.
Use of PPOCUS in the evaluation of patients with symptomatic early pregnancy is associated with decreased LOS in patients ultimately diagnosed with intrauterine pregnancy. This review suggests that this finding is generalizable to a variety of practice settings.