Emergency department right upper quadrant ultrasound is associated with a reduced time to diagnosis and treatment of ruptured ectopic pregnancies

Objective: To determine whether the time to diagnosis and treatment of pati ents with ruptured ectopic pregnancy is significantly less for patients who had emergency department (ED) right upper quadrant (RUQ) ultrasound (US) c ompared with those who had US in the radiology department. Methods: The aut hors conducted a retrospective review of eligible patients presenting to an urban ED between January 1990 and December 1998. Patients were included in the study if they were seen in the ED, had a discharge diagnosis of ruptur ed ectopic pregnancy, were brought immediately to the operating room after a definitive diagnosis of ectopic pregnancy rupture was made, and had more than 400 mL of intraperitoneal blood found at the time of surgery. The ED, hospital, radiology, and operative records were reviewed to determine prese nting vital signs, intraperitoneal blood loss, time to diagnosis, time to t reatment, and type of US performed. Results: There were 37 patients enrolle d; 16 received ED RUQ US (group I) and 21 had a formal US in radiology (gro up II). The ages, pulses, systolic blood pressures, and volumes of hemoperi toneum were similar between the two groups. The average time to diagnosis f rom ED arrival was 58 minutes for group I (SD = 57; 95% CI = 28 to 87) and 197 minutes for group II (SD = 82; 95% CI = 162 to 232) (p less than or equ al to 0.0001). The average time to operative treatment was 111 minutes (gro up I) (SD = 86; 95% CI = 69 to 153) and 322 minutes (group II) (SD = 107; 9 5% CI = 270 to 364) (p less than or equal to 0.0001), respectively. Conclus ions: Patients with ruptured ectopic pregnancy, who were selected to have R UQ US performed in the ED by emergency physicians, had an average decrease in time to diagnosis of two and a quarter hours, and an average decrease in time to treatment of three and a half hours, compared with those having a formal pelvic US in the radiology department. Further prospective investiga tion is needed to determine whether ED RUQ US can safely expedite care of p atients with suspected ectopic pregnancy.