Accuracy of emergency physicians using ultrasound measurement of crown-rump length to estimate gestational age in pregnant females

• Published in: The American journal of emergency medicine Vol. 30; no. 8; pp. 1627 - 1629
• Main Authors: Bailey, Caitlin, MD, Carnell, Jennifer, MD, Vahidnia, Farnaz, MD, PhD, Shah, Sachita, MD, Stone, Michael, MD, Adams, Mickeye, MD, Nagdev, Arun, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier; Elsevier Limited
• Subjects: Abdomen; Accuracy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cross-Sectional Studies; Crown-Rump Length; Drug therapy; Emergency; Emergency and intensive care: techniques, logistics; Emergency medical care; Emergency Medicine - standards; Emergency Medicine - statistics & numerical data; Female; Gestational Age; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Medical sciences; Menstruation; Observational studies; Physician assistants; Point-of-Care Systems; Pregnancy; Prenatal care; Prospective Studies; Teaching hospitals; Training; Ultrasonography, Prenatal - statistics & numerical data; Pregnancy; Intensive care; Length measurement; Physician; Emergency; Ultrasound; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2011.12.002

Abstract Study objective The objective of this study is to evaluate the accuracy of emergency providers (EPs) of various levels of training in determination of gestational age (GA) in pregnant patients using bedside ultrasound measurement of crown-rump length (CRL). Methods We conducted a prospective, cross-sectional, observational study of patients in obstetrical care at an urban county hospital. We enrolled a convenience sample of women at 6 to 14 weeks gestation as estimated by last menstrual period. Emergency providers used ultrasound to measure the CRL. Repeat CRL measurements were performed by either an obstetrical ultrasound technician or senior obstetrician and used as the criterion standard for true GA (TGA). Results One hundred five patients were evaluated by 20 providers of various levels of training. The average time required to complete the CRL measurement was 85 seconds. When CRL measurements performed by EPs were compared with the TGAs, the average correlation was 0.935 (0.911-0.959). Using standard accepted variance for CRL measurements at different GAs according to the obstetrics literature (±3 days for 42-70 days and ±5 days for 70-90 days), correlation between EP ultrasound and measured TGA was 0.947 (0.927-0.967). Conclusions Emergency providers can quickly and accurately determine GA in first-trimester pregnancies using bedside ultrasound to calculate the CRL. Emergency providers should consider using ultrasound to calculate the CRL in patients with first-trimester bleeding or pain because this estimated GA may serve as a valuable data point for the future care of that pregnancy.