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Pelvic exam in the ED

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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

Sexually active adolescent with lower abdominal pain needs:

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pemsou5_wp • November 22, 2019

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  1. Kelly December 2, 2019 - 11:03 pm Reply

    The value of the pelvic exam for emergency department patients has been investigated in a few studies. Brown et al West J Emerg Med 2011;12(2):208 looked at 183 women with acute abdominal pain or vaginal bleeding who underwent pelvic exam. They found that only 6% (12 cases) had an unexpected finding on exam that led to a change in management. Linden et al Ann Emerg Med 2017;70(6):825 randomized 202 women in early pregnancy with abdominal pain or vaginal bleeding to pelvic or no pelvic exam. They found no significant difference in a composite morbidity outcome, although their power was insufficient and their confidence intervals were wide. Farrukh et al Ann Emerg Med 2018;72(6):703 studied 288 patients aged 14-20 years old with pelvic pain or vaginal discharge. They found that pelvic exam did not improve on the sensitivity/specificity for diagnosing cervicitis and PID beyond simple history and urine NAT tests for chlamydia, gonorrhea, and trichomonas (27.4% of the population had an STD), although in 71 patients the results of the pelvic exam changed medical management.

  2. Kelly December 4, 2019 - 8:59 pm Reply

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