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Pelvic exam in the ED
(Click the link to comment and to vote – voting not working through email, sorry!)
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!
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Kelly December 2, 2019 - 11:03 pm
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.
Kelly December 4, 2019 - 8:59 pm
Didn’t realize emDOCs just covered this topic! http://www.emdocs.net/speculations-on-the-speculum-is-a-pelvic-exam-ever-needed-in-the-ed/