Emergency Department Clinical Pathway for Evaluation of
Post-Pubertal Girls with Lower Abdominal Pain and No Vaginal Bleeding
Initial FLOC, RN Team Assessment
- Assess
- Pain, hydration, peritoneal sign
- Obtain Urine
- Clean: HCG, POC
- Dirty: STI testing, as clinically indicated
- Consider
- NPO, need for IV, labs
- IVF to fill bladder
- Serum HCG (promote bladder filling)
Positive Pregnancy
- Determine need for transfer to HUP
- STI screening, treatment as clinically indicated
- SW consult, counseling
- Safe discharge plan
Indications for Pelvic US
- Severe pain
- Significant focality to pain
- Palpable mass on PE
- Uncertain diagnosis
- Elevated inflammatory markers
- Consider retrograde bladder filling if high concern for ovarian torsion
Consent for HIV Testing, Guidance for
Delivering Test Results to Patients
See Indications for Pelvic Ultrasound
Possible Surgical Disease
- Ovarian Torsion
- Appendicitis
Possible Medical Disease
- Pyelonephritis
- Urolithiasis
- Gastroenteritis
- Constipation
- Ovarian cyst
- Mittelschmerz
- IBS
- Functional
Social Work Consult
Health Educator
Health Educator
Indications for Admission
- Inpatient Treatment
- Age < 15 years
- Immunodeficiency
- TOA
- Severe disease
- Vomiting, significant dehydration
- Concern for follow-up, compliance
- Pregnancy
- Uncertain Diagnosis
- Reassuring H&P
- Able to tolerate PO
- Follow-up care available
- Discharge
Posted: April 2006
Revised: September 2011, April 2015, October 2017, December 2017, April 2020 (Reviewed), September 2020
Authors: C. Mollen, MD, J. Lavelle, MD, M. Zucker, MD
Revised: September 2011, April 2015, October 2017, December 2017, April 2020 (Reviewed), September 2020
Authors: C. Mollen, MD, J. Lavelle, MD, M. Zucker, MD
Related Links
- For Providers:
Sexually Transmitted Diseases Treatment Guidelines