BACKGROUND AND PURPOSE: 

• Point-of-care ultrasound in the emergency department (ED) to establish pregnancy viability and location appears to be more efficient than referring the patient out  
• Morgan et al. (Journal of Ultrasound in Medicine, 2018) sought to assess whether early prenatal ultrasound performed on site in ED by emergency physicians rather than the radiology department led to reduced ED length of stay (LOS)

METHODS: 

• Randomized multi-centered controlled clinical trial (RCT)  
  • Clinically stable adult pregnant women  
  • ≤20 weeks 
  • Presenting to ED with abdominal pain or vaginal bleeding 
  • 24 hour radiology coverage at all sites 
• Women were assessed for intrauterine pregnancy (IUP) in one of the following arms 
  • Point-of-care ultrasound by trained ED physician  
  • Radiology department  
• Primary outcome: ED LOS 
  • Time from exam room to admission or discharge 
• Secondary outcome 
  • Time to the diagnostic result 
  • The study adjusted for variability in location, as different sites may have different workflows

RESULTS: 

• 122 in the point-of-care US arm | 111 in the radiology arm 
• ED LOS was significantly shorter in the point‐of‐care US arm (P = .014)  
  • 181 minutes vs 201 minutes  
  • Median difference, –20 minutes (95% CI, –54 to 7 minutes) 
  • Adjusting for variability due to the location, the ED LOS was 31 minutes shorter (95% CI, –64 to 1 min)  
• Excluding patients with inconclusive point-of-care results (i.e., crossed over to radiology arm) 
  • ED LOS in the point-of-care arm was 75 minutes shorter than in the radiology US arm (95% CI, –97 to –53 min) 
• Patients randomized to point-of-care but also received radiology ultrasound had the  
  • Longest LOS (246 minutes; 95% CI, 210 to 286 minutes)  
  • Longest time to the diagnostic result (180 minutes; 95% CI, 158 to 211 minutes)

CONCLUSION: 

• Women tested for IUP were discharged earlier when point-of-care US was used rather than radiology US, even in centers with 24 hour radiology coverage

Learn More – Primary Sources: 

Effect of Emergency Physician–Performed Point-of-Care Ultrasound and Radiology Department-Performed Ultrasound Examinations on the Emergency Department Length of Stay Among Pregnant Women at Less Than 20 Weeks’ Gestation

Related ObG Topics:

Early Pregnancy Loss: How to Make the Ultrasound Diagnosis

Managing Early Pregnancy Loss