Benign emergencies, as defined for this study, included acute conditions expected to resolve spontaneously or with appropriate medical treatment selleckchem such as uncomplicated ectopic pregnancy, uncomplicated

pelvic inflammatory disease, uncomplicated cyst, intra-cystic hemorrhage, myoma, endometriotic lesions, and pelvic adhesions. Data analysis The preoperative physical and TVUS examinations, recorded as normal or abnormal, were compared to the laparoscopy findings as indicating a surgical emergency or a benign emergency. We used multiple logistic regression to compute the crude and adjusted diagnostic odds ratios (DORs) of having a laparoscopically confirmed surgical emergency depending on the preoperative clinical and TVUS results. The parameter values of the model were estimated using the maximum likelihood ratio method. The adjusted diagnostic odds ratios (aDORs) and their confidence intervals (CIs) were computed from the model coefficients and their standard deviations. P values lower than 0.05 were considered significant. To compare the performances of physical examination alone, TVUS alone, and both in combination for diagnosing a surgical emergency, we computed sensitivity (Se), specificity (Sp), and the positive and negative

likelihood ratios Selleckchem PI3K Inhibitor Library (LR+ and LR-). In the strategy including both examinations in combination, the results were considered to suggest a surgical emergency if the physical examination OR the TVUS OR both showed abnormalities; this strategy reflected routine use of TVUS in first PTK6 line, regardless of clinical findings as we perform at our ED. To be clinically effective and safe, a first-line diagnostic strategy had to have a low false-negative rate (i.e., sensitivity of 95% or more), with sufficient sensitivity to produce an LR- lower than 0.25.

The three different strategies were compared based on the 95% confidence intervals (95% CIs) for Se and Sp according to Taylor’s formula [20]. If the point estimate of one value was not included within the 95% CI of the other, then they differed significantly with P smaller than 0.05. The analyses were first performed on the overall population of patients then separately in the pregnant and nonpregnant patients. The required sample size was estimated as follows. The expected prevalence of surgical emergencies among patients who underwent laparoscopy was 50%. Using computation of the 95% CI with an unknown ratio estimator of the standard deviation, including 200 patients with laparoscopy would produce a lower limit of the 95% CI of 0.95 if the true false-negative rate is less than or equal to 2%.