BACKGROUND AND PURPOSE:

• Okada et al. (American Journal of Emergency Medicine, 2021) performed an external validation of the POP score to predict presence of ObGyn disorder in the ED

METHODS:

• Multi-center, retrospective cohort study (2017 to 2020)
  • 3 hospitals | None involved in the initial development of the POP score
• Population
  • Young adult women aged 16 to 49 years with abdominal pain in the ED
• POP score
  • Screening tool to assess the likelihood of underlying obstetrics and gynecological diseases
  • The POP score is comprised of three predictors, each worth one point
    • Past history of ObGyn diseases: +1 if present
    • Other Symptoms (fever or digestive symptoms): +1 if not present
    • Peritoneal irritations signs: +1 if present
  • In a previous study, if POP score was 3 points (the max), the risk of OBGYN disease was 55%; if the score was 0, the risk was 1 to 2%
• Study design
  • The POP score was used to calculate the probability of Obgyn diseases, using logistic regression
  • Predictions were compared with observations to evaluate the calibration of the mode
• Primary outcome
  • Screening performance characteristics of the POP score
    • Sensitivity | Specificity | Likelihood ratio

RESULTS:

• 1026 women
  • Median (IQR) age: 31 (23 to 41) years
• Discrimination performance of the POP score (AUC): 0.645 (95% CI, 0.603 to 0.687)
• The predicted probabilities of OBGYN diseases using the POP score was generally well-calibrated to the observations
• When the cut-off was set between 2 and 3 points for the ruling in of OBGYN diseases
  • Sensitivity: 0.064 (95% CI, 0.026 to 0.127)
  • Specificity: 0.993 (95% CI, 0.986 to 0.998)
  • Positive likelihood ratio: 9.72 (95% CI, 3.33 to 28.4)
  • Utility of POP score to rule in ObGyn condition
• When the cut-off was set between 0 and 1 points for ruling out of OBGYN diseases
  • Sensitivity: 0.973 (95% CI, 0.922 to 0.994)
  • Specificity: 0.151 (95% CI, 0.128 to 0.175)
  • Negative likelihood ratio: 0.181 (95% CI, 0.059 to 0.558)
  • Utility of POP score to rule out ObGyn condition
• Non-ObGyn diagnoses
  • Most patients who did not receive an ObGyn diagnosis had GI disease (e.g., infectious enteritis)

CONCLUSION:

• The POP score to predict ObGyn disorders was externally validated for use in the emergency department for women presenting with abdominal pain
• A POP score of 2 to 3

…would encourage vaginal examinations and pelvic or transvaginal ultrasonography for making the definitive diagnosis of OBGYN disease in an early phase, resulting in an efficient clinical process

• A Pop Score of 1 to 2 would direct evaluation toward GI or GU pathology and consideration given to

… additional tests (e.g., blood test, transabdominal ultrasonography, and computed tomography)

Learn More – Primary Sources:

External validation of the POP score for predicting obstetric and gynecological diseases in the emergency department

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