: Ectopic pregnancy is a significant problem in the United States, with an estimated 108,800 cases diagnosed per year and a rising incidence. Ectopic pregnancy disproportionately affects the disadvantaged female population. Early, accurate detection of ectopic pregnancy diminishes morbidity and mortality and reduces costs associated with repeat emergency department visits, hospitalization, surgery, and future infertility evaluation. Despite being a common clinical problem, physicians in the emergency department miss the diagnosis in more than 40% of ectopic pregnancies on the initial visit. In an attempt to improve diagnostic accuracy for this disease, some emergency physicians have begun to perform and interpret bedside pelvic ultrasound examinations on patients they suspect of having ectopic pregnancy. In addition to improving diagnostic accuracy, this approach also has the potential to improve efficiency in the emergency department. However, the impact in terms of costs and the quality improvement characteristics of pelvic ultrasound use by emergency physicians in the evaluation of ectopic pregnancy have not been evaluated thoroughly. The candidate has expertise in the field of emergency ultrasound. The purpose of the proposed application is to develop the candidate into an independent investigator in the field of quality improvement in the acute care setting through formal training and practical experience. The training goal of the applicant will be to complete a Masters of Clinical Research (MCR) at the University of California, San Francisco (UCSF). UCSF has a strong history of providing the ideal setting, mentors and resources for such training. The practical experience goal will be achieved through a prospective observational study of pregnant females presenting to the emergency department at risk for ectopic pregnancy. Consecutive patients will receive ultrasound by the emergency physician and also by a blinded radiologist. The primary goal of this study will be to assess the test characteristics of pelvic ultrasound performed by emergency physicians for the purpose of excluding ectopic pregnancy compared to two types of referent standards: (1) ultrasound examination performed and interpreted by radiologists, and (2) clinical outcomes. The secondary goal will be to assess the costs related to this new technology. This proposal will lay a research foundation for further examination of quality issues in emergency healthcare.
| Wang, Ralph; Reynolds, Teri A; West, Hugh H et al. (2011) Use of a ?-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med 58:12-20 |
| Stein, John C; Wang, Ralph; Adler, Naomi et al. (2010) Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med 56:674-83 |
| Tang, Ning; Stein, John; Hsia, Renee Y et al. (2010) Trends and characteristics of US emergency department visits, 1997-2007. JAMA 304:664-70 |
| Stein, John C; River, Gerin; Kalika, Irina et al. (2009) A survey of bedside ultrasound use by emergency physicians in California. J Ultrasound Med 28:757-63 |
