Initial Evaluation of Pelvic Organ Prolapse in the Emergency Department

Objectives: Our study sought to describe the presenting characteristics, modes of evaluation and interventions, and follow-up amongst women seeking initial care for pelvic organ prolapse in the emergency department.

Methods: This was a retrospective study of patients who presented for care at three separate emergency departments (ED) associated with a single tertiary referral center and received an ICD10 code diagnosis of pelvic organ prolapse (POP) between January 1, 2016 and September 30, 2022. Patients who had previously undergone evaluation for POP or presented for a complication or treatment related to their established POP were excluded. Data elements extracted from the electronic medical record include demographic variables, chief complaint, assessment and treatment in the ED, and whether there was follow-up care with a urogynecologist within three months post-ED discharge. Descriptive statistics and bivariate analyses were used to determine statistical significance and compare characteristics amongst women who did not follow-up for urogynecologic care.

Results: Fifty-six female patients met inclusion criteria, with a mean age of 61.2 + 17.1 years. Most of these women identified as Black or African American (57.1%) and Hispanic or Latino (21.4%). English was the primary language for the majority (89.3%). The most common chief complaint was vaginal bulge (53.6%) followed by pelvic pain (17.9%) and urinary symptoms (10.7%). Evaluation principally was comprised of physical examination (98.0%) and imaging (44.6%), with the main imaging modalities being CT abdomen and pelvis (30.4%) and pelvic ultrasound (23.0%). The predominant intervention was manual reduction of the prolapse (23.2%). Consultation with gynecology and urogynecology was performed in 28.6% and 8.9% of patients, respectively. Approximately one-third (35.7%) of women underwent follow-up care with a urogynecologist within three months after their ED discharge. There was no statistically significant difference in race, ethnicity, language, or insurance status among patients who ultimately did and did not access timely follow-up. Results are shown in Table 1 and Table 2 below.

Conclusions: Pelvic organ prolapse can cause sufficient distress for an individual to prompt a visit to the ED. Our study is the first to investigate the relationships between the utilization of the ED for initial evaluation of prolapse and follow-up care. Thus, it is evident that further research is needed to understand factors associated with the use of the ED as a contact point for new POP presentation and detect any differential variables amongst patients accessing urogynecology follow-up care, in order to improve clinical outcomes.