Point-of-Care Ultrasound After Medical Screening Exam Reduces Time to Ruptured Ectopic Pregnancy Diagnosis and Surgery.
- 1McGovern Medical School at University of Texas Health Science Center Houston, Department of Emergency Medicine, Houston, Texas.
- 2UCLA-Ronald Reagan/Olive View, Olive View, California.
- 3Rush University, Department of Emergency Medicine, Chicago, Illinois.
Abstract
Introduction
Ectopic pregnancy remains the leading cause of first-trimester maternal mortality. Delays in diagnosis and operative management increase morbidity and may be exacerbated by emergency department (ED) crowding. We evaluated whether integration of point-of-care ultrasound (POCUS) into the medical screening exam of pregnant patients-the obstetric medical screening exam-was associated with improved timeliness of care for patients with surgically managed ectopic pregnancy.Methods
We conducted a single-center retrospective cohort study of adult patients undergoing operative management for ruptured ectopic pregnancy between January 1, 2019, and December 31, 2023, at a county safety-net hospital. The obstetric screening exam was implemented July 12, 2021, and incorporated focused transabdominal pelvic and right upper quadrant ultrasound into the initial ED evaluation, often prior to bed assignment. The primary outcome was time from ED arrival to operating room (OR). Secondary outcomes included time to obstetric consultation, time to hospital admission, ED length of stay (LOS), and POCUS use. Nonparametric testing was used for skewed time data. Logistic regression evaluated the odds of reaching the OR within four hours. Patient-level interrupted time series analysis assessed temporal trends.Results
A total of 150 patients were included (87 pre- and 63 post-implementation). Median arrival-to-OR time decreased from 516 minutes (interquartile range [IQR] 324-709.5) to 391 minutes (IQR 220-619), a 125-minute reduction (P = .020; bootstrap 95% CI, 8-233). The proportion of patients reaching the OR within four hours increased from 16.1% to 31.8% (odds ratio 2.42; 95% CI, 1.11-5.29; P = .02). Time to obstetric consultation (210 vs 146 minutes; P = .003), time to hospital admission (345 vs 250 minutes; P = .005), and ED LOS (451 vs 367 minutes; P = .03) were all reduced. Point-of-care ultrasound use increased from 41.4% to 66.7% (P < .001), while the remainder underwent radiology ultrasound. Interrupted time series analysis demonstrated no significant immediate change after implementation (P = .790), but a significant postintervention trend toward reduced arrival-to-OR time (-0.45 minutes/day, P = .01).Conclusion
Embedding POCUS into the medical screening examination in triage was associated with sustained improvement in operative timeliness for ruptured ectopic pregnancy. Early diagnostic integration within ED workflow may mitigate system-level delays in time-sensitive obstetric emergencies.
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BibTeX
@article{morris2026pointofcare,
title = {{Point-of-Care Ultrasound After Medical Screening Exam Reduces Time to Ruptured Ectopic Pregnancy Diagnosis and Surgery.}},
author = {Victoria L Morris and Michael Vu and Yongsu Lee and Evelyn Park and Ravi Soni and Ryan Walsh and Rachel Bower and John C Waller-Delarosa and Kunal Sharma and Benjamin L Karfunkle and Richard Gordon},
journal = {The western journal of emergency medicine},
year = {2026},
month = sep,
doi = {10.5811/westjem.53932},
url = {https://europepmc.org/article/MED/42900937},
note = {CC BY},
}
RIS
TY - JOUR
TI - Point-of-Care Ultrasound After Medical Screening Exam Reduces Time to Ruptured Ectopic Pregnancy Diagnosis and Surgery.
AU - Victoria L Morris
AU - Michael Vu
AU - Yongsu Lee
AU - Evelyn Park
AU - Ravi Soni
AU - Ryan Walsh
AU - Rachel Bower
AU - John C Waller-Delarosa
AU - Kunal Sharma
AU - Benjamin L Karfunkle
AU - Richard Gordon
PY - 2026
DA - 2026/09/24
JO - The western journal of emergency medicine
DO - 10.5811/westjem.53932
UR - https://europepmc.org/article/MED/42900937
AB - Introduction Ectopic pregnancy remains the leading cause of first-trimester maternal mortality. Delays in diagnosis and operative management increase morbidity and may be exacerbated by emergency department (ED) crowding. We evaluated whether integration of point-of-care ultrasound (POCUS) into the medical screening exam of pregnant patients-the obstetric medical screening exam-was associated with improved timeliness of care for patients with surgically managed ectopic pregnancy.Methods We conducted a single-center retrospective cohort study of adult patients undergoing operative management for ruptured ectopic pregnancy between January 1, 2019, and December 31, 2023, at a county safety-net hospital. The obstetric screening exam was implemented July 12, 2021, and incorporated focused transabdominal pelvic and right upper quadrant ultrasound into the initial ED evaluation, often prior to bed assignment. The primary outcome was time from ED arrival to operating room (OR). Secondary outcomes included time to obstetric consultation, time to hospital admission, ED length of stay (LOS), and POCUS use. Nonparametric testing was used for skewed time data. Logistic regression evaluated the odds of reaching the OR within four hours. Patient-level interrupted time series analysis assessed temporal trends.Results A total of 150 patients were included (87 pre- and 63 post-implementation). Median arrival-to-OR time decreased from 516 minutes (interquartile range [IQR] 324-709.5) to 391 minutes (IQR 220-619), a 125-minute reduction (P = .020; bootstrap 95% CI, 8-233). The proportion of patients reaching the OR within four hours increased from 16.1% to 31.8% (odds ratio 2.42; 95% CI, 1.11-5.29; P = .02). Time to obstetric consultation (210 vs 146 minutes; P = .003), time to hospital admission (345 vs 250 minutes; P = .005), and ED LOS (451 vs 367 minutes; P = .03) were all reduced. Point-of-care ultrasound use increased from 41.4% to 66.7% (P < .001), while the remainder underwent radiology ultrasound. Interrupted time series analysis demonstrated no significant immediate change after implementation (P = .790), but a significant postintervention trend toward reduced arrival-to-OR time (-0.45 minutes/day, P = .01).Conclusion Embedding POCUS into the medical screening examination in triage was associated with sustained improvement in operative timeliness for ruptured ectopic pregnancy. Early diagnostic integration within ED workflow may mitigate system-level delays in time-sensitive obstetric emergencies.
SN - 1936-900X
SN - 1936-9018
ER -