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Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology.

Huchon C, Dumont A, Chantry A, Falissard B, Fauconnier A - World J Emerg Surg (2014)

Bottom Line: In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation.Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation.In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France.

ABSTRACT

Objective: Acute pelvic pain is a common reason for emergency room visits that can indicate a potentially life-threatening emergency (PLTE). Our objective here was to develop a triage process for PLTE based on a self-assessment questionnaire for gynecologic emergencies (SAQ-GE) in patients experiencing acute pelvic pain.

Methods: In this multicenter prospective observational study, all gynecological emergency room patients seen for acute pelvic pain between September 2006 and April 2008 completed the SAQ-GE after receiving appropriate analgesics. Diagnostic procedures were ordered without knowledge of questionnaire replies. Laparoscopy was the reference standard for diagnosing PLTE; other diagnoses were based on algorithms. In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation.

Results: Of 344 derivation-set patients and 172 validation-set patients, 96 and 49 had PLTEs, respectively. Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation. Sensitivity of the decision tree based on these three features was 87.5% (95% confidence interval (95% CI), 81%-94%) in the derivation set and 83.7% in the validation set. Derivation of the decision tree provided probabilities of PLTE of 13% (95% CI, 6%-19%) in the low-risk group, 27% (95% CI, 20%-33%) in the intermediate-risk group and 62% (95% CI, 48%-76%) in the high-risk group, ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%). In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%.

Conclusion: A simple triage model based on a standardized questionnaire may assist in the early identification of patients with PLTEs among patients seen in the gynecology emergency room for acute pelvic pain.

No MeSH data available.


Related in: MedlinePlus

Decision tree for classifying the risk of potentially-life-threatening emergency in patients presenting to gynecological emergency rooms with acute pelvic pain.
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Figure 1: Decision tree for classifying the risk of potentially-life-threatening emergency in patients presenting to gynecological emergency rooms with acute pelvic pain.

Mentions: Table 2 reports the results of the univariate analysis. None of the SAQ-GE items had Lr + values greater than 4 or Lr- values lower than 0.25.Figure 1 shows the decision tree, in which three items are taken into account sequentially: vomiting, sudden onset of pain, and pain upon self-palpation. Patients with no vomiting or pain upon palpation are at low risk, with a probability of PLTE of 13% (95% CI, 6%-19%). The intermediate risk group is defined based on either no vomiting but pain upon self-palpation or vomiting but no sudden onset of pain; the probability of a PLTE is 27% (95% CI, 20%-33%). In the high-risk group, with both vomiting and sudden-onset pain, the probability of a PLTE is 62% (95% CI, 48%-76%), ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%) (Figure 1). Sensitivity of the decision tree was 87.5% (95% CI, 81%-94%).


Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology.

Huchon C, Dumont A, Chantry A, Falissard B, Fauconnier A - World J Emerg Surg (2014)

Decision tree for classifying the risk of potentially-life-threatening emergency in patients presenting to gynecological emergency rooms with acute pelvic pain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4150681&req=5

Figure 1: Decision tree for classifying the risk of potentially-life-threatening emergency in patients presenting to gynecological emergency rooms with acute pelvic pain.
Mentions: Table 2 reports the results of the univariate analysis. None of the SAQ-GE items had Lr + values greater than 4 or Lr- values lower than 0.25.Figure 1 shows the decision tree, in which three items are taken into account sequentially: vomiting, sudden onset of pain, and pain upon self-palpation. Patients with no vomiting or pain upon palpation are at low risk, with a probability of PLTE of 13% (95% CI, 6%-19%). The intermediate risk group is defined based on either no vomiting but pain upon self-palpation or vomiting but no sudden onset of pain; the probability of a PLTE is 27% (95% CI, 20%-33%). In the high-risk group, with both vomiting and sudden-onset pain, the probability of a PLTE is 62% (95% CI, 48%-76%), ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%) (Figure 1). Sensitivity of the decision tree was 87.5% (95% CI, 81%-94%).

Bottom Line: In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation.Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation.In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France.

ABSTRACT

Objective: Acute pelvic pain is a common reason for emergency room visits that can indicate a potentially life-threatening emergency (PLTE). Our objective here was to develop a triage process for PLTE based on a self-assessment questionnaire for gynecologic emergencies (SAQ-GE) in patients experiencing acute pelvic pain.

Methods: In this multicenter prospective observational study, all gynecological emergency room patients seen for acute pelvic pain between September 2006 and April 2008 completed the SAQ-GE after receiving appropriate analgesics. Diagnostic procedures were ordered without knowledge of questionnaire replies. Laparoscopy was the reference standard for diagnosing PLTE; other diagnoses were based on algorithms. In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation.

Results: Of 344 derivation-set patients and 172 validation-set patients, 96 and 49 had PLTEs, respectively. Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation. Sensitivity of the decision tree based on these three features was 87.5% (95% confidence interval (95% CI), 81%-94%) in the derivation set and 83.7% in the validation set. Derivation of the decision tree provided probabilities of PLTE of 13% (95% CI, 6%-19%) in the low-risk group, 27% (95% CI, 20%-33%) in the intermediate-risk group and 62% (95% CI, 48%-76%) in the high-risk group, ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%). In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%.

Conclusion: A simple triage model based on a standardized questionnaire may assist in the early identification of patients with PLTEs among patients seen in the gynecology emergency room for acute pelvic pain.

No MeSH data available.


Related in: MedlinePlus