Clinical Predictors for Reproductive-aged Gynecologic Emergency Surgery Candidates Presenting to the Emergency Department with Acute Abdominal Pain

ABSTRACT

PURPOSE: Differentiating gynecological emergency surgery indications among reproductive-age female patients presenting with acute abdominal pain is challenging for emergency department (ED) physicians. We evaluated the clinical demographics of female patients diagnosed with gynecological surgery indications in the ED and found clinical predictors associated with surgical indications overall and with each surgical indication. METHODS: We conducted a prospective review study of the hospital registries of reproductive-aged women who presented with abdominal pain but without underlying disease from April 2008 to October 2010. These registries included information concerning the patient's basic characteristics, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. Using a multivariate logistic regression analysis, we found a number of statistically significant factors indicating a gynecological emergency necessitating surgery. RESULTS: A total of 1047 cases involving female patients of reproductive age were initially included. We found 89 patients(8.50%) who were diagnosed as having gynecological surgery indications: 50(4.78%) were diagnosed with hemorrhagic ovarian cyst rupture, 16(1.53%) with ectopic pregnancy, and 23(2.20%) with ovarian torsion. Pain of more than 14 days from the last menstrual period (OR, 2.332; 95% CI, 1.406-3.968; p=0.001), bilateral lower abdominal tenderness (OR, 0.467; 95% CI, 0.288-0.758; p=0.002), rebound tenderness (OR, 0.54; 95% CI, 0.329-0.887; p=0.015), normal C-reactive protein value (CRP) (OR, 3.286; 95% CI, 1.717-6.290; p<0.001), and positive human chorionic gonadotropin test (OR, 0.058; 95% CI, 0.024-0.142; p<0.001) were related to gynecologic emergency surgery indication in a patient with abdominal pain. CONCLUSION: Clinical findings of the last menstrual period, bilateral abdominal tenderness, rebound tenderness, CRP value, and urine hCG result can be helpful in exclusion of gynecologic emergency surgical indications.