Ultrasound availability in the evaluation of ectopic pregnancy in the ED: Comparison of quality and cost-effectiveness with different approaches
Ultrasound availability in the evaluation of ectopic pregnancy in the ED: Comparison of quality and cost-effectiveness with different approaches
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DOI：
10.1053/ajem.2000.7310
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发表时间：
2000-07-01
影响因子：
3.6
通讯作者：
Ackerson, LM
中科院分区：
文献类型：
--
作者：
Durston, WE;Carl, ML;Ackerson, LM
超声检查被广泛应用于妊娠早期痉挛或出血的患者，以避免在急诊科（艾德）误诊为异位妊娠。不同方法的超声可用性的成本效益以前没有报道。在这项研究中，我们调查了6年内在艾德发现异位妊娠的质量和成本效益的措施，分为三个大致相等的时期，采用三种不同的超声方法。该研究回顾性地确定了6年内在艾德发现的120例异位妊娠。首次访视时记录为无宫内妊娠（IUP）的异位妊娠患者百分比显著改善，从第1阶段的76%（通过医学成像（MI Sono）进行超声检查的可用性有限）改善至第2阶段的88%（MI Sono可随时使用），再至第3阶段的96%，当Mi Sono和急诊医生（艾德Sane）的超声检查都很容易获得时（P = .02）。急诊医生为有宫外孕风险的患者订购的MI Sonos估计数量从第1阶段的每次宫外孕5.2个增加到第2阶段的每次宫外孕11.8个，并在第3阶段下降到每次宫外孕5.5个，当时还为每个宫外孕订购了19.9个艾德Sonos。第3期艾德Sono的成本被避免在常规医学成像部门工作时间后呼叫超声技术人员所节省的费用所抵消。艾德Sono在IUP中的特异性为100%（95% Ct 98.3 - 100%），但对反映从首次艾德访视到第3阶段治疗的时间的次要质量指标进行分析，发现某些艾德Sono可能遗漏了附件肿块或输卵管破裂体征。我们的结论是，超声检查的可用性增加，导致提高质量的异位妊娠的检测在艾德，但代价是不成比例的增加，在每个异位妊娠检测的超声检查的数量。我们的研究表明，最具成本效益的策略是急诊医生使用艾德Sonos筛查所有妊娠早期痉挛和出血的患者，并在艾德Sono不确定或未显示IUP的所有病例中，在首次艾德访视时获得MI Sonos。
The liberal use of ultrasonography has been advocated in patients with first trimester cramping or bleeding to avoid misdiagnosis of ectopic pregnancy in the emergency department (ED). The cost-effectiveness of different approaches to ultrasound availability has not been previously reported. in this study, we investigated measures of quality and cost-effectiveness in detecting ectopic pregnancy in the ED over a 6-year period, divided into three approximately equal epochs with three distinct approaches to ultrasound availability The study retrospectively identified 120 cases of ectopic pregnancy seen in the ED over 6 years. There was significant improvement in the percentage of patients with ectopic pregnancy who were documented to have absence of intrauterine pregnancy (IUP) at the first visit from 76% during Epoch 1, when there was limited availability of ultrasound through medical imaging (MI Sono), to 88% in Epoch 2, when MI Sono was readily available, to 96% in Epoch 3, when both Mi Sono and ultrasound by emergency physicians (ED Sane) were readily available (P = .02). The estimated number of MI Sonos ordered by emergency physicians in patients at risk for ectopic pregnancy increased from 5.2 per ectopic pregnancy in Epoch 1 to 11.8 per ectopic pregnancy in Epoch 2, and declined to 5.5 per ectopic pregnancy in Epoch 3, when 19.9 ED Sonos per ectopic pregnancy were also done. The cost of ED Sono in Epoch 3 was more than offset by savings from avoiding calling in ultrasound technicians after regular medical imaging department hours. The specificity of ED Sono in ruling in an IUP was 100% (95% Ct 98.3 to 100%), but analysis of secondary quality indicators reflecting times from first ED visit to treatment in Epoch 3 raised the possibility that an adnexal mass or signs of tubal rupture may have been missed on some ED Sonos. We conclude that increased availability of ultrasonography leads to improved quality in the detection of ectopic pregnancy in the ED, but at the expense of a disproportionate increase in the number of ultrasound studies done per ectopic pregnancy detected. Out study suggests that the most cost-effective strategy is for emergency physicians to screen all patients with first trimester cramping and bleeding with ED Sonos, and to obtain MI Sonos at the time of the initial ED visit in all cases in which the ED Sono is indeterminate or shows no IUP.