Can patient history and physician suspicion accurately exclude pregnancy?

Yes, according to a study published in The American Journal of Emergency Medicine.  The goal of the study was to determine if a woman's self-assessment of her pregnancy status was reliable.  The hypothesis was that there was a very low chance of pregnancy in a woman who felt that her being pregnant was impossible.

The study included 377 adult women of childbearing age who came to the emergency department for a variety of reasons.  These women were asked to identify their pregnancy status as "impossible," "possible," or "definite."  Similarly, the treating physician was also also asked to estimate their patient's likelihood for pregnancy as "high," "moderate," or "low."  All women had either a urine or a serum hCG test performed.

So how'd they do?  Well, 65% of the women thought it was "impossible" that they were pregnant and they were right.  None of them had a positive hCG test.  The doctors did just as well.  None of the patients that they ranked as having a "low" chance of being pregnant were.  The study concluded that routine pregnancy testing may not be required in adult women of childbearing age.  The researchers don't go so far as to suggest that pregnancy testing should never be done if suspicion is low and caution that hCG tests should be done on patients with high-risk signs of ectopic pregnancy regardless of what the patient (or their history) suggests.

There are a few problems with this study though.

  • First, there is no indication of which patients had a urine hCG test and which ones had a serum test.  These two tests aren't the same and urine tests probably aren't as good at ruling-out pregnancy as serum hCG tests are.
  • Second, the researchers acknowledge that all of the women in the study were seen at one suburban medical center and that they may have been confident of their pregnancy status due to the use of home pregnancy tests.  The women were also likely to be more knowledgeable about their bodies and safe sex practices.  Clearly these women don't represent the diversity of patients seen in different emergency departments.

Still, I thought the study was interesting.  And, in an time when lab tests often seem to be used with impunity, it was refreshing to consider the diagnostic value of what the patient reports and what their physician thinks.

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