WP7.7 - TRUST: Transvaginal Ultrasound for Surgery Evaluation and Treatment. The use of invasive tests in the right iliac fossa surgical pathway

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Abstract Transvaginal ultrasound (TVUS) is an invasive intimate test with strict guidance on its utilisation. This tool is commonly used in General surgery (GS) as a decision aid for operative or non-operative management. Aims Ensure patient selection for TVUS was equivalent in Gynae and GS pathways. Determine the influence of TVUS on the decision to operate. Ensure patients were consented adequately comparatively between general surgery and gynaecology. Methods This was a mixed methods study with retrospectively collected data from 1400 woman undergoing TVUS for RIF pain presenting to Gynae or GS in a DGH. Interviews were conducted with 50 GS and 50 Gynae patients. Ultrasound, blood, and histology results were reviewed. A positive GS TVUS was defined as free fluid or appendicitis, Gynae pathology was excluded. Interviews consisted of 8 likert scale questions on the process. Ethical approval was given by the hospital ethics committee. Results A total of 1445 patients were included (825 admitted under GS and 620 under gynae). Median age for the GS cohort was 28 and gynae 31 with no statistical difference in baseline characteristics. TVUS was positive in 14.8% of GS patients. Positive patients were more likely to proceed to laparoscopy (OR 2.43, 95% CI 1.46-4.03, p <.05). 50% of these had histologically confirmed appendicitis. Similarly, patients with raised WCC or CRP were more likely to proceed to laparoscopy (OR 1.87, 95% CI 1.26-2.76, p <.05); 56% had histologically confirmed appendicitis. There were no significant differences interviews. Conclusion TVUS remains an invasive tool, with similar diagnostic profile to blood tests. Careful consideration should be given to its use.

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