Table 2 Diagnostic accuracy of physical examination, transvaginal ultrasonography,

and both for diagnosing surgical emergencies   Physical examination alone TVUS alone Strategy combining physical examination andTVUS† Se% (n/N) [95% CI] Sp% (n/N) [95% CI] LR + LR – Se (n/N) [95% CI] Sp (n/N) [95% CI] LR+ Dabrafenib LR – Se (n/N) [95% CI] Sp (n/N) [95% CI] LR+ LR – Overall population 87% (121/139) [82–93] 33% (31/95) [23–42] 1.3 0.4 94% (131/139) [90–98] 27% (26/95) [18–36] 1.3 0.2 99% (138/139) [98–100] 7% (7/95) [2–13] 1.1 0.1 Pregnant women 84% (81/97) [76–91] 42% (22/53) [28–55] 1.4 0.4 96% (93/97) [92–100] 13% (7/53) [4–22] 1.1 0.3 99% (96/97) [97–100] 6% (3/53) [0–12] 1.1 0.2 Non-pregnant women 95% (40/42) [89–100] 21% (9/42) [19–34] 1.2 0.2 91% (38/42) [82–99] 45% (19/42) [30–60] 1.6 0.2 100% (42/42) [92 – 100] 10% (4/42) [1–18] 1.1 0 Se, sensitivity; CI, confidence interval; Sp, specificity; LR, likelihood ratio. †Corresponds to a strategy of routine TVUS regardless of the clinical findings, abnormal findings include abnormal examination OR abnormal TVUS. TVUS, transvaginal ultrasonography; Se, sensitivity; Sp, specificity;

LR+, positive likelihood ratio; LR-, negative likelihood ratio; 95%CI, 95 % confidence interval. Table 3 Diagnoses in patients with a laparoscopy diagnosis of surgical emergency PI3K Inhibitor Library price but had negative physical examination or negative transvaginal ultrasonography or negative with both examinations combined   FN, physical examination, n (%) FN, TVUS, n (%)

FN, physical examination combined with TVUS†, n (%) Total number of patients with surgical emergencies, N Ectopic pregnancy 14 (15%) 1 (1%) 0 91 Pelvic peritonitis 0 1 (4 %) 0 25 Adnexal torsion 3 (20%) 3 (20%) 1 (7%) 15 Appendicitis 0 1 (25%) 0 4 Intestinal obstruction 0 2 (100%) 0 2 Ruptured hemorrhagic cyst 1 (50%) 0 0 2 Total 18 (13%) 8 (6%) 1 (0.7%) 139 Percentages were computed by dividing the number of false negatives by the total number of surgical emergencies. FN, False negatives; TVUS, transvaginal ultrasonography. †Corresponds to a strategy of routine TVUS regardless of the clinical findings, abnormal findings include abnormal examination OR abnormal TVUS. The strategy combining physical examination and TVUS in first-line was better than the strategy including only physical examination acetylcholine according to our criteria in which surgical emergencies were suspected based on abnormal clinical OR TVUS findings. This strategy decreased the false-negative rate from 13% (physical examination alone) to less than 1% (Table  3). The strategy combining physical examination and TVUS was the one maximizing Se and decreased negative LR to an acceptable rate of 0.1. When pregnant and nonpregnant patients were analyzed separately, the results were unchanged (Table  2). Discussion According to our data, physical examination cannot be used alone to safely rule out a surgical emergency in a woman presenting with acute pelvic pain.