Plight of the pelvic exam
| Autor: | Mary McLean, Livia Santiago-Rosado |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
media_common.quotation_subject Medical Overuse Critical Care and Intensive Care Medicine Intrauterine pregnancy Pelvic Exams 03 medical and health sciences 0302 clinical medicine Obstetrics and gynaecology Intervention (counseling) medicine Humans Vaginal bleeding 030212 general & internal medicine Quality of Health Care media_common Selection bias business.industry General surgery 030208 emergency & critical care medicine General Medicine medicine.anatomical_structure Clinical diagnosis Emergency Medicine Vagina Gynecological Examination medicine.symptom business |
| Zdroj: | Emergency Medicine Journal. 36:383-384 |
| ISSN: | 1472-0213 1472-0205 |
| Popis: | > I was worried about vaginas. I was worried what we think about vaginas, and I was even more worried that we don’t think about them. > — Eve Ensler, The Vagina Monologues 1 In recent years, a series of clinical studies have questioned the utility of the pelvic exam, and have concluded that it may be routinely omitted from patient evaluations in the ED. Tintinalli’s 2016 text states: ‘ Vaginal examinations in stable women presenting with first-trimester bleeding may add little to the clinical diagnosis; some providers are moving away from routine use of vaginal examinations in initial patient assessment as long as a transvaginal US is obtained .’2 A recent article in Emergency Medicine News was boldly entitled ‘Why Are You Still Performing Pelvic Exams?’ as if it were already an obsolete intervention.3 Yet a closer examination of the literature suggests these conclusions are far too premature. Several studies have evaluated the practice of obtaining a pelvic ultrasound in pregnant patients prior to, or possibly in lieu of, a pelvic exam. In 2017, Annals of Emergency Medicine published a study by Linden et al , suggesting that pelvic exams for ED patients with vaginal bleeding or lower abdominal pain, and ultrasound-confirmed first-trimester intrauterine pregnancy (IUP), may be unnecessary.4 This prospective, randomised equivalence trial measured the composite morbidity (unscheduled return, subsequent admission, emergency procedure, transfusion, infection and alternate source of symptoms) in the intervention (no pelvic exam) and control (pelvic exam performed) groups. The observed difference (−2.4% in the intervention arm) was not statistically significant, with a vast CI (−11.8% to 7.1%). The study was far underpowered: designed to involve 720 patients, it only enrolled 202 patients. Selection bias may have occurred: enrolment took place only on weekdays, for 15 hours/day; and language barriers were among their exclusion criteria, which may … |
| Databáze: | OpenAIRE |
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