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Reliability of bimanual pelvic examinations performed in emergency departments
R J Close1, C J Sachs, P L Dyne
1University of California, Los Angeles (UCLA) Emergency Medicine Center, 924 Westwood Blvd, Ste 300, Los Angeles, CA 90024, USA. rclose@pol.net
Objective:
To test the reliability of bimanual pelvic examinations performed in emergency departments by emergency medicine physicians.
Design:
Prospective observational study; 2 examiners each recorded various pelvic examination findings on 186 patients.
Setting:
A private university hospital and a public county hospital staffed by attending emergency medicine physicians who share an emergency medicine residency program.
Subjects:
Senior resident (3rd or 4th year) and attending emergency physicians.
Main Outcome Measures:
Percentage of agreement and percentage of positive agreement for cervical motion tenderness, uterine tenderness, adnexal tenderness, adnexal mass, and uterine size (within 2 cm).
Results:
The agreement ranged between 71% and 84%, but the percentage of positive agreement was much lower, ranging from 17% to 33%. Agreement for uterine size, within 2 cm, was 60%.
Conclusion:
The findings of bimanual pelvic examinations performed by emergency physicians in an emergency department have poor interexaminer reliability.