The original ACEP guidelines can be found here.
This table from (Annals of Emergency Medicine Volume 58, Issue 1, July 2011, Pages 12–20) shows the IUPs eventually discovered on f/u vs. what was seen in the ED at various thresholds of bHCGs.
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Scott Weingart
An ED Intensivist from NY.
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Scott- agree with all you said in this podcast.. I think the major problem with the use of a single discriminatory zone, lies largely in the definition of IUP. These old studies with 1500-2000 endocavitary, and 6000-6500 for trans-abdominal, are all based on the definition of IUP being a gestational sac. With our current definition of at least seeing yolk sac to call it IUP (due to pseudogesational sacs), I don’t think those old numbers for discriminatory zone even apply anymore whatsoever: When we’re talking about discriminatory zone for Yolk Sac, the numbers, as expected, much higher: Here’s a study showing this– check out the numbers: http://www.ncbi.nlm.nih.gov/pubmed/23262929 I don’t understand why everyone keeps pretending that this zone is even at all applicable anymore when they were based on gestational sac, and we’re looking for yolk sac. I think this is the study you referred to in the audio- when you factor in Emergency Physicians performing the ultrasound, and the disparity in ultrasound equipment, etc…now the discriminatory zone is even that much more, way, ridiculously off: http://emupdates.com/perm/Wang%20Discriminatory%20Zone%202011%20AnnEM.pdf What ends up happening is OB gets consulted on a ton of stable patients, with no evidence of ectopic on ultrasound bc of a… Read more »
[…] review Dr. Scott Weingart’s Practical Evidence Podcast #3 – ACEP 2012 Management of Early Pregnancy, in which he summaries the ACEP 2012 Clinical Policy on this […]