For instance, vomiting strongly predicted both tubal rupture [10] and adnexal torsion [28]. Most gynecological emergencies may involve the same general protective mechanisms triggered in response to danger, such as activation of the autonomic nervous system [26, 27]. Thus, acute pelvic pain and other symptoms as described by women may serve as warning signals that can provide diagnostic orientation. Limitations One limitation of our study is related to our definition of

PLTE. This definition was not established by consensus among a panel of experts [29]. Nevertheless, our definition of PLTE GANT61 ic50 is consistent with clinical reality in Cisplatin mouse patients with gynecological emergencies. For instance, ectopic pregnancy can be life threatening in the event of tubal rupture with hemodynamic shock from massive intraabdominal bleeding. In this situation,

substandard care is often related to misdiagnosis [3, 6]. We extended this concept to all gynecological emergencies that may not pose an immediate threat but may worsen rapidly. Sepantronium cell line We used acute pelvic pain as the warning signal for such situations. Our definition of PLTE is similar to that used pragmatically in general emergency rooms with the goal of identifying conditions likely to cause serious subsequent manifestations (http://​www.​acem.​org.​au/​media/​policies_​and_​guidelines/​G24_​Implementation_​_​ATS.​pdf). In patients with PLTEs as defined for our study, an earlier and more accurate diagnosis allows the rapid provision of appropriate care, thereby improving patient outcomes in terms of both

morbidity and mortality. Another limitation may be overfitting of the decision tree to our data. However, the validation study in the third of our population not used to build the decision tree showed similar diagnostic performance characteristics and substantial overfitting was also prevented by constructing the SAQ-GE in a preliminary study involving different patients and experts. Conclusion In summary, our decision tree is the first dedicated to the diagnosis of PLTEs with a 87.5% sensitivity. In addition, it relies on only three simple items of a self-questionnaire. We plan to study the extent to which our decision tree decreases time to appropriate many management and improves outcomes in patients presenting with acute pelvic pain to crowded emergency rooms. Funding Assistance Publique-Hôpitaux de Paris (AP-HP). References 1. Kontoravdis A, Chryssikopoulos A, Hassiakos D, Liapis A, Zourlas PA: The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain. Int J Gynecol Obstet 1996, 52:243–248.CrossRef 2. Alouini S, Mesnard L, Coly S, Dolique M, Lemaire B: [Gynecological emergencies: etiology and degree of gravity.]. J Gynecol Obstet Biol Reprod (Paris) 2012, 41:48–54.CrossRef 3. Abbott J, Emmans LS, Lowenstein SR: Ectopic pregnancy: ten common pitfalls in diagnosis. Am J Emerg Med 1990, 8:515–522.PubMedCrossRef 4.