急诊科床旁即时超声对早期妊娠中急诊科停留时间和诊断时间的影响：一项系统评价与荟萃分析。
完整摘要 · 中文译文
背景：早期妊娠并发症是急诊科（ED）就诊的重要原因，而异位妊娠仍然是孕产妇死亡的主要原因之一。 目的：本系统综述和荟萃分析旨在评估急诊科床旁超声（POCUS）与标准放射科或产科超声（US）在急诊环境下早期妊娠评估中的有效性。 方法：系统检索了四个数据库，纳入就诊于急诊科的早期妊娠（孕周<20周）患者的研究。分析了急诊就诊时间（LOS）、诊断时间、异位妊娠患者的手术时间以及异位妊娠漏诊率方面的差异。计算了加权均数差（WMD）和风险比（RR）及其95%置信区间（CI）。本研究已在国际前瞻性系统综述注册数据库注册（ID CRD420251242734）。 结果：共纳入13项研究，涉及4057例早期妊娠患者（急诊POCUS组1848例，标准超声组2209例）。与标准影像检查相比，急诊POCUS与急诊就诊时间的统计学显著缩短相关（WMD -59.53，95% CI -77.43至-41.62，p < 0.00001），也与明确诊断时间的统计学显著缩短相关（WMD -80.93，95% CI -119.10至-42.77，p < 0.0001）。此外，汇总分析显示，急诊POCUS与标准超声在异位妊娠漏诊率方面无统计学显著差异（RR 1.22，95% CI 0.39-3.87，p = 0.73）。 结论：急诊POCUS与急诊护理的可测量改善相关。 效率，且异位妊娠漏诊率无统计学显著增加。未来需要开展高质量、多中心的随机研究，以更好地明确急诊科床旁超声（ED POCUS）在早期妊娠评估中的诊断准确性、安全性和普遍适用性。
完整摘要 · 英文原文
BACKGROUND: Early pregnancy complications represent a substantial reason for emergency department (ED) visits, with ectopic pregnancy remaining a significant cause of maternal mortality. OBJECTIVES: This systematic review and meta-analysis aim to evaluate the effectiveness of ED point-of-care ultrasound (POCUS) vs. standard radiology- or obstetric-performed ultrasound (US) for early pregnancy assessment in emergency settings. METHODS: Four databases were systematically searched for studies including patients with early pregnancy (<20 weeks of gestation) presenting to the ED. Differences in ED length of stay (LOS), time to diagnosis, time to surgery for patients with ectopic pregnancy, and the rate of missed ectopic cases were analyzed. Weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. The study was registered in the International Prospective Register of Systematic Reviews database (ID CRD420251242734). RESULTS: Thirteen studies with 4057 early pregnancy patients (ED POCUS = 1848 and standard US = 2209) were included. Compared with standard imaging, ED POCUS was associated with statistically significant reductions in ED LOS (WMD -59.53, 95% CI -77.43 to -41.62, p < 0.00001) and time to definitive diagnosis (WMD -80.93, 95% CI -119.10 to -42.77, p < 0.0001). Moreover, pooled analysis reported no statistically significant difference in the rate of missed ectopic cases between ED POCUS and standard US (RR 1.22, 95% CI 0.39-3.87, p = 0.73). CONCLUSION: ED POCUS is associated with measurable improvements in emergency care efficiency without a statistically significant increase in missed diagnoses of ectopic pregnancy. Future high-quality, multicenter randomized studies are needed to better define the diagnostic accuracy, safety, and generalizability of ED POCUS in early pregnancy evaluation.